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*

Malignancies of the pancreatobiliary system are usually unresectable at the time of diagnosis. As a consequence, a majority of these cases are candidates for palliative care. With advances in chemotherapeutic agents and multidisciplinary care, the survival rate in pancreatobiliary malignancies has improved. Therefore, there is a need to provide an effective and long-lasting palliative care for these patients. Endoscopic palliation is preferred to surgery as the former is associated with equal efficacy and reduced morbidity. The main role of endoscopic palliation in the vast majority of pancreatobiliary malignancies includes biliary and enteral stenting for malignant obstructive jaundice and gastric outlet obstruction, respectively. Recent advances in endoscopic palliation appear promising in imparting long-lasting relief of symptoms. Use of radiofrequency ablation and photodynamic therapy in malignant biliary obstruction has been shown to improve the survival rates as well as the patency of biliary stents. The emergence of endoscopic ultrasound (EUS) as a therapeutic tool has enhanced the capability of minimally invasive palliation in pancreatobiliary cancers. EUS is a valuable alternative to endoscopic retrograde cholangiopancreatography for the palliation of obstructive jaundice. More recently, EUS is emerging as an effective primary modality for biliary and gastric bypass.
Catheter Ablation ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Gastric Bypass ; Gastric Outlet Obstruction ; Humans ; Jaundice, Obstructive ; Palliative Care ; Pancreatic Neoplasms ; Photochemotherapy ; Stents ; Survival Rate ; Ultrasonography

Pancreatic cancer is a leading cause of cancer-related morbidity and mortality, but any meaningful improvement in its prognosis remains elusive. The lack of early diagnostic methods means that many patients only present when symptoms develop, such as obstructive jaundice. Once a diagnosis of pancreatic cancer has been made in a patient with obstructive jaundice, then a decision should be made if the patient is a candidate for surgical resection. Patients who are candidates for surgical resection generally do not need preoperative biliary drainage, unless they present with cholangitis, or if they require neo-adjuvant chemotherapy. If preoperative biliary drainage is to be done, then patient factors and local expertise should guide appropriate interventions. The evidence for endoscopic retrograde cholangiopancreatography as a first-line therapy for biliary decompression is strong; However, the use of percutaneous transhepatic biliary drainage as well as endoscopic ultrasound-guided biliary drainage has generally not been found to be inferior. Finally, to ensure ongoing patency and minimize complications, an appropriate self-expanding metal stent should ideally be placed.
Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Decompression ; Diagnosis ; Drainage ; Drug Therapy ; Endoscopy ; Humans ; Jaundice, Obstructive ; Mortality ; Pancreatic Neoplasms ; Prognosis ; Stents ; Ultrasonography

Common bile duct (CBD) stone is a relatively frequent disorder with a prevalence of 10-20% in patients with gallstones. This is also associated with serious complications, including obstructive jaundice, acute suppurative cholangitis, and acute pancreatitis. Early diagnosis and prompt treatment is the most important for managing CBD stones. According to a recent meta-analysis, endoscopic ultrasonography and magnetic resonance cholangiopancreatography have high sensitivity, specificity, and accuracy for the diagnosis of CBD stones. Endoscopic ultrasonography, in particular, has been reported to have higher sensitivity between them. A suggested management algorithm for patients with symptomatic gallstones is based on whether they are at low, intermediate, or high probability of CBD stones. Single-stage laparoscopic CBD exploration and cholecystectomy is superior to endoscopic retrograde cholangiopancreatography (ERCP) plus laparoscopic cholecystectomy with respect to technical success and shorter hospital stay in high risk patients with gallstones and CBD stones, where expertise, operative time, and instruments are available. ERCP plus laparoscopic cholecystectomy is usually performed to treat patients with CBD stones and gallstones in many institutions. Patients at intermediate probability of CBD stones after initial evaluation benefit from additional biliary imaging. Patients with a low probability of CBD stones should undergo cholecystectomy without further evaluation. Endoscopic sphincterotomy and endoscopic papillary balloon dilation in ERCP are the primary methods for dilating the papilla of Vater for endoscopic removal of CBD stones. Endoscopic papillary large balloon dilation is now increasingly performed due to the usefulness in the management of giant or difficult CBD stones. Scheduled repeated ERCP may be considered in patients with high risk of recurrent CBD stones.
Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Cholangitis ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Choledocholithiasis ; Common Bile Duct* ; Diagnosis ; Early Diagnosis ; Endosonography ; Gallstones ; Humans ; Jaundice, Obstructive ; Length of Stay ; Operative Time ; Pancreatitis ; Prevalence ; Sensitivity and Specificity ; Sphincterotomy, Endoscopic

BACKGROUND/AIMS: Little is known about the treatment or outcomes of hepatocellular carcinoma (HCC) complicated with bile duct invasion. METHODS: A total of 247 consecutive HCC patients with bile duct invasion at initial diagnosis were retrospectively included. RESULTS: The majority of patients had Barcelona Clinic Liver Cancer (BCLC) stage C HCC (66.8%). Portal vein tumor thrombosis was present in 166 (67.2%) patients. Median survival was 4.1 months. Various modalities of treatment were initially employed including surgical resection (10.9%), repeated transarterial chemoembolization (TACE) (42.5%), and conservative management (42.9%). Among the patients with obstructive jaundice (n=88), successful biliary drainage was associated with better overall survival rate. Among the patients with BCLC stage C, overall survival differed depending on the initial treatment for HCC; surgical resection, TACE, systemic chemotherapy, and conservative management showed overall survival rates of 11.5, 6.0 ,2.4, and 1.6 months, respectively. After adjusting for confounders, surgical resection and repeated TACE were significant prognostic factors for HCC patients with bile duct invasion (hazard ratios 0.47 and 0.39, Ps <0.001, respectively). CONCLUSIONS: The survival of HCC patients with bile duct invasion at initial diagnosis is generally poor. However, aggressive treatments for HCC such as resection or biliary drainage may be beneficial therapeutic options for patients with preserved liver function.
Bile Ducts* ; Bile* ; Carcinoma, Hepatocellular* ; Diagnosis ; Drainage ; Drug Therapy ; Humans ; Jaundice, Obstructive ; Liver ; Liver Neoplasms ; Portal Vein ; Prognosis ; Retrospective Studies ; Survival Rate ; Thrombosis

Malignant biliary tract obstruction (MBTO) is caused by a group of neoplasms that compromise bile duct flow, and the clinical presentation includes obstructive jaundice. The optimal treatment depends on both the type of malignancy and the stage of disease. Surgical resection may be the first choice of treatment. However, an operation is often impossible because of locally advanced disease or a high metastatic potential at the time of diagnosis. Considering the unfavorable prognosis of unresectable MBTO, endobiliary radiofrequency ablation (EB-RFA) has emerged as a palliative therapeutic modality that directly ablates malignant tissue in the bile duct. To date, some reports have suggested that EB-RFA is possibly beneficial, but it remains unclear whether EB-RFA prolongs biliary stent patency or overall survival. Nevertheless, EB-RFA is regarded as a promising loco-regional therapy for MBTO. This review focuses on the clinical application of the technique and its appropriate use, along with the benefits afforded and the complications encountered.
Bile Ducts ; Biliary Tract ; Biliary Tract Neoplasms ; Catheter Ablation* ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Jaundice, Obstructive ; Pancreatic Neoplasms ; Prognosis ; Stents

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

Primary biliary mucosa-associated lymphoid tissue (MALT) lymphoma is extremely rare. We report a case of primary biliary MALT lymphoma with obstructive jaundice diagnosed by endoscopic biopsy, without surgical intervention. Obstructive jaundice was relieved by endoscopic drainage and endoscopic biopsy was done simultaneously during endoscopic retrograde cholangiopancreatography. Unnecessary surgical intervention can be avoided after pathological confirmation of lymphoma. The patient received radiotherapy, and is alive without any evidence of recurrence or biliary obstruction. Diagnosis of primary biliary lymphoma is very difficult because of its low prevalence. However, it should always be considered as a differential diagnosis, since when an accurate diagnosis is made, unnecessary surgical intervention can be avoided.
Biopsy ; Cholangiocarcinoma ; Cholangiopancreatography, Endoscopic Retrograde ; Diagnosis ; Diagnosis, Differential ; Drainage ; Humans ; Jaundice, Obstructive ; Klatskin Tumor* ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone* ; Prevalence ; Radiotherapy ; Recurrence

Hepaticojejunostomy is an important part of many surgical procedures including pancreaticoduodenectomy. Biliary leakage from hepaticojejunostomy may be associated with intraabdominal abscess formation, biliary peritonitis, and even mortality. A 72-year-old female patient was admitted to our hospital with obstructive jaundice. After initial evaluation, she was diagnosed with distal common bile duct obstruction without accurate diagnosis. Before planned pancreaticoduodenectomy, biliary drainage with a T-tube was performed due to the presence of cholangitis. After the first operation, pancreaticoduodenectomy was performed. Postinflammatory changes around the hilar region made the hepaticojejunostomy risky. A bilio-digestive anastomosis was performed using a new technique. A nasogastric tube was placed into the common bile duct proximal to the anastomosis. The postoperative course of the patient was uneventful. The use of a nasogastric tube as a stent in risky hepaticojejunostomies is a simple technique that can be beneficial.
Abscess ; Aged ; Bile* ; Cholangitis ; Common Bile Duct ; Diagnosis ; Drainage ; Female ; Humans ; Jaundice, Obstructive ; Mortality ; Pancreaticoduodenectomy* ; Peritonitis ; Stents

The patient was a 70-year-old male whose chief complaints were obstructive jaundice and weight loss. Abdominal imaging studies showed a 2.5 cm sized mass at the distal common bile duct, which was suggestive of bile duct cancer. Eccentric enhancing wall thickening in the transverse colon was also shown, suggesting concomitant colon cancer. A colonoscopy revealed a lumen-encircling ulcerofungating mass in the transverse colon, that was pathologically proven to be adenocarcinoma. The bile duct pathology was also adenocarcinoma. Pylorus-preserving pancreaticoduodenectomy and extended right hemicolectomy were performed under the diagnosis of double primary cancers. Postoperative histopathologic examination revealed moderately differentiated mucinous adenocarcinoma of transverse colon cancer, and mucinous adenocarcinoma of the distal common bile duct. Immunohistochemical staining studies showed that the bile duct cancer had metastasized from the colon cancer. The patient recovered uneventfully from surgery and will be undergoing chemotherapy for three months.
Adenocarcinoma ; Adenocarcinoma, Mucinous* ; Aged ; Bile Duct Neoplasms ; Bile Ducts ; Colon, Transverse* ; Colonic Neoplasms ; Colonoscopy ; Common Bile Duct Neoplasms ; Common Bile Duct* ; Diagnosis ; Drug Therapy ; Humans ; Jaundice, Obstructive* ; Male ; Mucins* ; Neoplasm Metastasis ; Pancreaticoduodenectomy ; Pathology ; Weight Loss