Extrahepatic bile duct obstruction and erosive disruption by cavitating porta hepatis nodal metastasis, treated by uncovered wallstent.
A 45-year-old woman with advanced gastric carcinoma presented with obstructive jaundice. Percutaneous transhepatic cholangiography (PTC) revealed erosive disruption of the extrahepatic bile ducts by a cavitating metastasis in the porta hepatis, as well as a biliary-duodenal fistula. External-internal biliary drainage via the fistula was plagued by recurrent drain occlusion by necrotic debris. This was ultimately alleviated by successful catheterization of the distal common bile duct (CBD) through the cavity, and linking the common hepatic duct (CHD) and CBD with a Wallstent, across the cavity. This succeeded in improving internal biliary drainage and isolating the exfoliating debris of the cavity from the bile ducts.
Trambert
Jonathan J
JJ
Department of Radiology, JD Weiler Hospital of the Albert Einstein College of Medicine, Bronx, NY 10461, USA. jtrambert@pol.net
Frost
Andrei
A
Malasky
Charlotte
C
D000230:Adenocarcinoma / Q000556:secondary / Q000628:therapy*; D001650:Bile Duct Neoplasms / Q000556:secondary / Q000628:therapy*; D017734:Bile Ducts, Extrahepatic; D001658:Biliary Fistula / Q000209:etiology; D002404:Catheterization / Q000295:instrumentation*; D001651:Cholestasis, Extrahepatic / Q000209:etiology / Q000628:therapy*; D004378:Duodenal Diseases / Q000209:etiology; D005260:Female; D006801:Humans; D007412:Intestinal Fistula / Q000209:etiology; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy; D008875:Middle Aged; D010166:Palliative Care; D011169:Portal Vein / Q000473:pathology; D015607:Stents; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome