A Case of Groove Pancreatic Cancer Diagnosed through Biliary Peritonitis Due to Intrahepatic Bile Duct Rupture

Background. Endoscopic retrograde cholangiopancreatography (ERCP) can lead to several complications such as duodenal or bile duct perforation. The incidence of pneumoperitoneum post-ERCP is rarely seen (<1%) and is associated with perforations of the duodenum or common bile duct in therapeutic ERCP after sphincterotomy. In this case, we disclose a novel cause of biliary peritonitis after ERCP. Case Presentation. A 65-year-old man presented with abdominal pain and distended abdomen after uneventful ERCP with sphincterotomy. An abdominal computed tomography (CT) was performed whose finding indicated duodenal perforation. The patient was rushed to an emergency laparotomy where only a rupture of an otherwise normal subcapsular intrahepatic bile duct was found. The surrounding liver parenchyma was healthy. The cause of this condition was probably post-ERCP pneumobilia and the increase of pressure in the biliary tract. Conclusions. This is the first case in literature describing the rupture of a subcapsular healthy bile duct as cause of biliary peritonitis after ERCP. This case also suggests that in the management of post-ERCP complications, the cooperation of radiologists and surgeons is vital for the patient’s wellbeing.

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A Case of Pancreatic Cancer with Invasion to the Wall of the Intrahepatic Bile Duct

Journal of UOEH ◽

10.7888/juoeh.9.187 ◽

1987 ◽

Vol 9 (2) ◽

pp. 187-191

Author(s):

Hiroshi MASUDA ◽

Yoshio TAOKA ◽

Akiko TSUNEYASU ◽

Joji HARATAKE

Keyword(s):

Pancreatic Cancer ◽

Bile Duct ◽

Intrahepatic Bile Duct

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Biliary peritonitis due to liver cyst rupture in autosomal dominant polycystic kidney disease

BMC Gastroenterology ◽

10.1186/s12876-021-01845-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hiroshi Matsuo ◽

Kan Katayama ◽

Aoi Hayasaki ◽

Yusuke Iizawa ◽

Mayumi Endo ◽

...

Keyword(s):

Bile Duct ◽

Kidney Disease ◽

Intrahepatic Bile Duct ◽

Liver Cyst ◽

Polycystic Kidney ◽

Abdominal Ct ◽

Biliary Peritonitis ◽

Autosomal Dominant Polycystic Kidney ◽

The Right ◽

Cyst Rupture

Abstract Background Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent genetic kidney disease and polycystic liver disease is its major extrarenal manifestation, however biliary peritonitis due to a liver cyst rupture is extremely rare. Case presentation The patient was a 71-year-old Japanese woman who was diagnosed with ADPKD 3 years previously and developed right abdominal pain suddenly 1 month previously. As abdominal computed tomography (CT) showed a ruptured liver cyst in the right lobe, she was admitted to our hospital. Her symptoms improved with conservative management and she was discharged from the hospital after 1 week. Although she was asymptomatic for a while, she noticed abdominal distension and general malaise at 1 month after hospital discharge. Since abdominal CT showed massive ascites, she was admitted to our hospital again. A physical examination revealed abdominal distention without tenderness. Her serum creatinine, alkaline phosphatase, γ-glutamyl transpeptidase, total bilirubin, and CA19-9 were elevated. Abdominal paracentesis revealed amber transparent ascites and the bilirubin and CA19-9 concentrations were high. She was diagnosed with biliary peritonitis due to a ruptured liver cyst. Hemodialysis treatment was initiated with drainage of the ascites. The outflow of the ascites was no tendency to decrease and drip infusion cholangiography (DIC)-CT revealed a communication between the ruptured cyst and an intrahepatic bile duct. On day 31, she was transferred to a university hospital and abdominal surgery was performed. After removing the necrotic roof of the ruptured cyst on the right liver lobe, the orifice of the bile leakage was sutured. Cholecystectomy was performed and cholangiography showed no stones in the common bile duct. Abdominal CT one month after the operation showed no recurrence of ascites and she was discharged on day 49. Hemodialysis treatment was discontinued immediately after discharge because urine volume increased and her creatinine level decreased. There has been no recurrence of ascites since then. Conclusions While rare, biliary peritonitis can occur in association with the rupture of a liver cyst in ADPKD patients due to communication between the cyst and the intrahepatic bile duct, and DIC-CT should be recommended when biliary cyst rupture is suspected.

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Localized Intrahepatic Bile Duct Dilatation without a Visible Mass or Stone as depicted on CT Images: Findings of Malignancy Prediction

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2008.59.3.163 ◽

2008 ◽

Vol 59 (3) ◽

pp. 163

Author(s):

Ju Wan Choi ◽

Gab Chul Kim ◽

Han Young Jeong ◽

Hui Joong Lee ◽

Jae Hyuck Lee ◽

...

Keyword(s):

Bile Duct ◽

Intrahepatic Bile Duct ◽

Ct Images ◽

Bile Duct Dilatation ◽

Duct Dilatation

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Type Va Duplication of Common Bile Duct (CBD) with Type IIIa Intrahepatic bile duct anatomy: A rare combination of Dual Biliary ductal anomaly with difficult to extract CBD stone

Journal of Clinical and Experimental Hepatology ◽

10.1016/j.jceh.2021.02.004 ◽

2021 ◽

Author(s):

Pankaj Singh ◽

Hitendra Kumar Garg ◽

Jayant Kumar Hota ◽

Sandeep Guleria ◽

Sandeep Vohra ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Intrahepatic Bile Duct ◽

Type Iiia ◽

Rare Combination ◽

Bile Duct Anatomy ◽

Cbd Stone

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A novel technique for mapping biopsy of bile duct cancer

Endoscopy ◽

10.1055/a-1248-2138 ◽

2020 ◽

Author(s):

Hirokazu Okada ◽

Norimitsu Uza ◽

Tomoaki Matsumori ◽

Shimpei Matsumoto ◽

Yuya Muramoto ◽

...

Keyword(s):

Bile Duct ◽

Intrahepatic Bile Duct ◽

Preoperative Assessment ◽

Median Number ◽

Novel Technique ◽

Minimal Trauma ◽

Adequate Sampling ◽

Novel Method ◽

Longitudinal Extension ◽

Mapping Biopsy

Abstract Background Accurate preoperative assessment of the longitudinal extension of perihilar cholangiocarcinoma (PHCC) is essential for treatment planning. Mapping biopsies for PHCC remain challenging owing to technical difficulties and insufficient sample amounts. The aim of this study was to investigate the usefulness of a novel technique for mapping biopsies of PHCC. Methods Our novel method focused on a biliary stent delivery system for mapping biopsies. Fifty patients with PHCC undergoing endoscopic transpapillary mapping biopsy using the novel method were reviewed from August 2015 to June 2019. Results The median number of biopsy samples was six (range 1 – 17), and the rate of adequate sampling was 91.4 % (266 /291). Biopsy from the intrahepatic bile duct was possible in 82.0 % of patients (41 /50), and negative margins were confirmed in the resected specimens from 34 /39 patients who underwent surgery (87.2 %). None of the patients had post-endoscopic retrograde cholangiopancreatography pancreatitis. Conclusions With our novel method, accurate assessment of the longitudinal extension of PHCC might be expected with minimal trauma to the duodenal papilla.

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