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Severe intrahepatic bile duct dilatation by hilar cholangiocarcinoma

  • Dao-Hui Wei
    Affiliations
    The First College of Clinical Medical Science, China Three Gorges University, Yichang, China

    Institute of Digestive Disease, China Three Gorges University, Yichang, China

    Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
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  • Yu-Kui Peng
    Affiliations
    The First College of Clinical Medical Science, China Three Gorges University, Yichang, China

    Institute of Digestive Disease, China Three Gorges University, Yichang, China

    Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
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  • Wei Liu
    Correspondence
    Correspondence to: Institute of Digestive Disease, China Three Gorges University, 8 Daxue Road, Yichang 443000, China.
    Affiliations
    The First College of Clinical Medical Science, China Three Gorges University, Yichang, China

    Institute of Digestive Disease, China Three Gorges University, Yichang, China

    Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
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Published:December 23, 2022DOI:https://doi.org/10.1016/j.amjms.2022.12.024

      Case presentation

      A 71-year-old woman presented to our gastroenterology clinic with a 1-month history of abdominal distension, pruritus, and jaundice along with clay-colored stools. She had no documented medical history. Physical examination was unremarkable. Laboratory tests of the blood confirmed elevated levels of a total bilirubin (210 μmol/L, reference range, 1.71–21 μmol/L), direct bilirubin (182 μmol/L, reference range, 1.71–13 μmol/L), alanine aminotransferase (219 U/L, reference range, 0–40 U/L), and CA19–9 (25,173 U/mL, reference range, 0–40 U/mL). Three-dimensional magnetic resonance cholangiopancreatogram showed severe intrahepatic biliary ductal dilatation with tapering and cutoff near the hilum (Fig. 1A). Esophagogastroduodenoscopy revealed the normal duodenal papilla. Contrast-enhanced abdominal computed tomography (CT) revealed tumors of the hilar bile duct about 3.6 cm in diameter with vessel involvement (Fig. 1B), which were consistent with hilar cholangiocarcinoma. The differential diagnosis of bile duct obstruction mainly includes common bile duct stones, acute cholangitis, cholangiocarcinoma, pancreatic head cancer, and ampullary tumors.
      • Bronswijk M.
      • Laurent M.R.
      • Van Olmen A.
      An Alternative Cause of Bile Duct Obstruction.
      • Guibaud L.
      • Bret P.M.
      • Reinhold C.
      • et al.
      Bile duct obstruction and choledocholithiasis: diagnosis with MR cholangiography.
      • Lähde S.
      Helical CT in the examination of bile duct obstruction.
      Ultrasound guided percutaneous transhepatic biliary drainage was performed to relieve the obstructive jaundice. Percutaneous liver puncture of tumor fragment guided by ultrasonography was performed and pathological examination confirmed the diagnosis of cholangiocarcinoma. The tumor was not considered to be resectable due to involvement of both the hepatic artery and the portal vein. In addition to biliary drainage, transcatheter arterial chemoembolization was pursued after a well-informed discussion of options for interventions with her. Finally, the patient passed away 11 months after interventional therapy.

      Ethical statement

      Written informed consent was obtained from the patient for publication of this “GI Image”.

      Source of funding

      None.

      Conflicts of Interest

      The authors have no conflicts of interest to declare.

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