Unusual cases of jaundice secondary to non-neoplastic bile duct obstruction.
Obstructive jaundice secondary to common bile duct stricture is most commonly attributed to malignancy. Here we present three unusual cases that mimicked carcinoma in presentation but were histologically diagnosed as benign inflammatory processes during operative care. The first case was attributed to obstruction-induced chronic pancreatitis secondary to Crohn's disease of the head of the pancreas, the second was due to sarcoidosis within periportal and extrahepatic biliary lymph nodes and distal common bile duct, and the third case was due to tuberculosis of biliary lymph nodes. All were successfully managed surgically, but potentially these patients may have been effectively treated pharmacologically, without the need for invasive surgical intervention, if an earlier diagnosis were available to the clinicians. A retrospective and comparative review of the data of each case demonstrated subtle clues such as multiple enlarged biliary lymph node involvement and only moderately elevated bilirubin levels that pointed toward possible nonmalignant processes.
Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Christian G
CG
Peyré
Mark
M
Wakim
Rod
R
Mateo
Yuri
Y
Genyk
Gagandeep
G
Singh
Robert Rick
RR
Selby
Nicolas
N
Jabbour
D000328:Adult; D001650:Bile Duct Neoplasms / Q000175:diagnosis; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D002908:Chronic Disease; D003137:Common Bile Duct Diseases / Q000150:complications; D003424:Crohn Disease / Q000150:complications; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D010195:Pancreatitis / Q000150:complications; D012507:Sarcoidosis / Q000150:complications; D014388:Tuberculosis, Lymph Node / Q000150:complications; D019564:Unnecessary Procedures