Extrahepatic biliary tract tumors are rare and among them rhabdomyosarcoma is most common. Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor and is a very rare malignancy of the common bile duct in children. It usually presents as obstructive jaundice and/or pruritus. If there is no local invasion to the adjacent tissues, the radiological appearance of the tumor lesion is like a choledochal cyst. So the diagnosis is usually made at surgery or by preoperative biopsy. It is important to diagnose early and differentiate it from choledochal cyst and start treatment as early as possible for long time survival of the patient. This case report presented a case of a 10-year-old boy with recurrent onset of obstructive jaundice and fever preoperatively who was diagnosed as choledochal cyst and postoperatively as embryonal rhabdomyosarcoma of the common bile duct. After surgical resection and postoperative chemotherapy, the child had a good prognosis. So it is crucial to know that this rare tumor can mimic congenital choledochal cyst and it should be considered in the differential diagnosis of obstructive jaundice in children.
Child ; Choledochal Cyst ; Common Bile Duct/pathology* ; Diagnosis, Differential ; Humans ; Jaundice, Obstructive/etiology* ; Male ; Rhabdomyosarcoma, Embryonal/diagnosis*

Aged ; Bile Duct Diseases ; complications ; diagnostic imaging ; pathology ; Bile Duct Neoplasms ; diagnosis ; Carcinoma, Hepatocellular ; complications ; diagnostic imaging ; pathology ; Diagnosis, Differential ; Humans ; Jaundice, Obstructive ; etiology ; Klatskin Tumor ; diagnosis ; Liver Neoplasms ; complications ; diagnostic imaging ; pathology ; Male ; Middle Aged ; Thrombosis ; complications ; diagnostic imaging ; pathology ; Tomography, X-Ray Computed

Intraductal tumor invasion of hepatocellular carcinoma (HCC) is considered rare. Transarterial chemoembolization (TACE) is effective for tumor thrombus of HCC in the bile duct. However, a few cases of obstructive jaundice caused by migration of a tumor fragment after TACE have recently been reported. The aim of this study was to identify factors that affect tumor migration after TACE. At this writing, a review of the medical literature disclosed seven reported cases of biliary obstruction caused by migration of a necrotic tumor cast after TACE. We, herein, report on an additional case of acute obstructive cholangitis complicated by migration of a necrotic tumor cast after TACE for intrabile duct invasion of HCC, in a 71-year-old man. The tumor cast in the common bile duct was removed successfully using a basket during ERCP and was pathologically confirmed to be a completely necrotic fragment of HCC. The patient's symptoms showed dramatic improvement. In summary, physicians should be aware of acute obstructive cholangitis complicated by tumor migration in a patient undergoing TACE. We suggest that an intrabile duct invasion would be a major predisposing factor of tumor migration after TACE and drainage procedures such as ERCP or percutaneous transbiliary drainage could be effective treatment modalities in these patients.
Acute Disease ; Aged ; Antineoplastic Agents/administration & dosage ; Bile Ducts, Intrahepatic/pathology ; Carcinoma, Hepatocellular/*diagnosis/pathology/therapy ; Chemoembolization, Therapeutic/adverse effects ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis/*etiology ; Humans ; Jaundice, Obstructive/etiology ; Liver Neoplasms/*diagnosis/pathology/therapy ; Male ; Necrosis/pathology ; Sphincterotomy, Endoscopic ; Thrombosis/etiology ; Tomography, X-Ray Computed

No abstract available.
Aged, 80 and over ; Cholecystitis/*complications/diagnosis ; Hemobilia/diagnosis/*etiology ; Humans ; Jaundice, Obstructive/etiology ; Male

We report an extremely rare case of metastatic common bile duct cancer from pulmonary adenocarcinoma presenting as obstructive jaundice. The patient was a 76-year-old male, who presented with generalized weakness and right upper quadrant pain. Plain chest X-ray noted multiple small nodules in both lung fields. Abdominal computed tomography scan showed a stricture of the mid common bile duct along with ductal wall enhancement. Endoscopic retrograde cholangiography revealed a concentric, abrupt narrowing of the mid-common bile duct suggestive of primary bile duct cancer. However, pathology comfirmed metastatic common bile duct cancer arising from pulmonary adenocarcinoma with immunohistochemical study with thyroid transcriptional factor-1 (TTF-1).
Adenocarcinoma/*diagnosis/pathology/radiography ; Aged ; Brain Neoplasms/radiography/secondary ; Bronchoscopy ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct Neoplasms/*diagnosis/secondary ; DNA-Binding Proteins/metabolism ; Humans ; Immunohistochemistry ; Jaundice, Obstructive/*etiology ; Lung Neoplasms/*diagnosis/pathology/radiography ; Male ; Positron-Emission Tomography ; Tomography, X-Ray Computed

OBJECTIVE: To evaluate the outcomes of patients undergoing percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy. MATERIALS AND METHODS: Fifty patients (mean age, 62.4 years; range, 27-86 years) who underwent percutaneous placements of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy were included. The technical success rate, clinical success rate, complication rate, stent patency, patient survival and factors associated with stent patency were being evaluated. RESULTS: The median interval between the gastrectomy and stent placement was 23.1 months (range, 3.9-94.6 months). The 50 patients received a total of 65 stents without any major procedure-related complications. Technical success was achieved in all patients. The mean total serum bilirubin level, which had been 7.19 mg/dL +/- 6.8 before stent insertion, decreased to 4.58 mg/dL +/- 5.4 during the first week of follow-up (p < 0.001). Clinical success was achieved in 42 patients (84%). Percutaneous transhepatic biliary drainage catheters were removed from 45 patients (90%). Infectious complications were noted in two patients (4%), and stent malfunction occurred in seven patients (14%). The median stent patency was 233 +/- 99 days, and the median patient survival was 179 +/- 83 days. Total serum bilirubin level after stenting was an independent factor for stent patency (p = 0.009). CONCLUSION: Percutaneous transhepatic placement of a biliary stent for obstructive jaundice secondary to metastatic gastric cancer after gastrectomy is a technically feasible and clinically effective palliative procedure.
Adult ; Aged ; Aged, 80 and over ; Bile Duct Neoplasms/complications/secondary/*surgery ; Bile Ducts, Extrahepatic/*surgery ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Jaundice, Obstructive/diagnosis/etiology/*surgery ; Male ; Middle Aged ; Prosthesis Design ; Retrospective Studies ; *Stents ; Stomach Neoplasms/*complications/secondary/surgery ; Treatment Outcome

Hepatic peribiliary cysts (HPCs) are characterized by cystic dilatations of the peribiliary glands located throughout the branches of the biliary systems. Specifically, they are mainly located along the hepatic hilum and major portal tracts. The natural history and prognosis of HPCs are uncertain. In fact, almost all HPCs have been discovered incidentally during radiological examination or autopsy, and they are considered to be clinically harmless. Recently, several cases of HPCs associated with obstructive jaundice or liver failure were reported in patients with pre-existing liver disease in several studies. However, until now there have been no reports of such a case in Korea. Herein, we report a case of HPCs that show a disease course with a poor prognosis. These HPCs developed in a 47-year-old man with progressive alcoholic liver cirrhosis.
Bile Duct Diseases/complications/*diagnosis/radiography ; Cholangiopancreatography, Magnetic Resonance ; Cysts/*complications/radiography ; Humans ; Jaundice, Obstructive/etiology ; Liver Cirrhosis, Alcoholic/complications/*diagnosis/radiography ; Male ; Middle Aged ; Tomography, X-Ray Computed

We describe an unusual presentation of Clonorchis sinensis infection with obstructive jaundice due to duodenal papillitis which was relieved dramatically by endoscopic sphincterotomy. A 26-yr-old male presented with complaints of fatigue, weight loss and painless jaundice. The history was significant for frequent ingestion of raw freshwater fish. The patient underwent endoscopic retrograde cholangiopancreatography for evaluation of obstructive jaundice. The duodenal papilla was markedly edematous with a bulging configuration and hyperemic changes at the orifice. Cholangiography revealed mild bile duct dilatation and irregular wall changes with multiple indentations. However, there were no biliary stricture or stones noted as the cause of obstructive jaundice. We performed an endoscopic sphincterotomy for effective bile drainage through the duodenal papilla. After the sphincterotomy, the patient's jaundice was dramatically improved. Pathology of the duodenal papilla showed eosinophilic infiltration of the mucosa. Parasitic eggs, consistent with the diagnosis of C. sinensis, were found in the bile sample.
Adult ; *Ampulla of Vater ; Animals ; Anthelmintics/therapeutic use ; Bile/parasitology ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis/*diagnosis/parasitology/pathology ; Clonorchiasis/*diagnosis ; Clonorchis sinensis/drug effects/isolation & purification ; Duodenum/pathology ; Humans ; Jaundice, Obstructive/*diagnosis/etiology ; Male ; Praziquantel/therapeutic use ; Sphincterotomy, Endoscopic ; Tomography, X-Ray Computed

Biopsy ; methods ; Drainage ; Humans ; Jaundice, Obstructive ; etiology ; therapy ; Lymph Node Excision ; methods ; Neoplasm Staging ; Pancreatic Neoplasms ; complications ; diagnosis ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Salvage Therapy

BACKGROUND/AIMS: Metal stent insertion through percutaneous transhepatic biliary drainage (PTBD) track is an important palliative treatment modality for malignant biliary obstruction. Acute pancreatitis is one of serious complications of biliary metal stenting. The purpose of this study was to investigate the risk of pancreatitis for patients who underwent metal stent insertion via PTBD track. METHODS: A retrospective analysis of 90 consecutive patients who received metal stent insertion via PTBD track from Jan. 2002 to Dec. 2007 was carried out. Patients were devided into the transpapillary and non-transpapillary group, and the risks of pancreatitis were compared. The effects of preliminary endoscopic sphincterectomy (EST) was also investigated in transpapillary group. RESULTS: The rate of pancreatitis was higher in transpapillary group compared to nontranspapillary group (odd ratio 1.87, 95% CI 0.516-6.761), but it showed no stastically significance (p=0.502). In transpapillary group, patients who received preliminary EST showed lower rate of pancreatitis (odd ratio 0.91, 95% CI 0.656-1.273), but it showed no stastically significance (p=0.614). CONCLUSIONS: Metallic stent insertion through the intact sphincter of Oddi might have a risk of developing pancreatitis. Further study is needed to elucidate the mechanism of pancreatitis and the way of prevention.
Aged ; Aged, 80 and over ; Amylases/metabolism ; Cholestasis/diagnosis/*surgery ; Drainage ; Female ; Humans ; Jaundice, Obstructive/diagnosis/*surgery ; Male ; Middle Aged ; Pancreatitis/*etiology ; Retrospective Studies ; Risk Assessment ; Sphincterotomy, Endoscopic ; Stents/*adverse effects