title: An unusual post-traumatic case of extrahepatic bile duct compression.
abstract: Jaundice and cholestatic disease by external bile duct compression may be caused by several conditions, including pancreatic masses, portal cavernoma, Ormond's disease, metastases from gallbladder cancer, neurinomas, and hydronephrotic kidney. We report a case of bile duct compression in a 56-year-old man with a known small (28 mm) right renal cyst and crossed, fused renal ectopia. The patient had a history of recent abdominal trauma due to a motorcycle accident and recurrent septic-type fever and jaundice. He also reported a weight loss of 5 kg in the last two months. Abdominal ultrasonography showed intra- and extra-hepatic bile duct dilatation, and computed tomography scan showed hydronephrosis, dilatation of intra- and extra-hepatic biliary tract, and a right renal complex cyst of more than 9 cm. One can hypothesize a relationship between the abdominal trauma and the increase in size of the renal cyst, which, moreover, had changed its original shape. The patient underwent cefuroxime and metronidazole therapy, with complete recovery from the cholangitis within one week. The treatment of choice would have been surgical excision or, alternatively, an image-guided percutaneous aspiration of the cyst, in order to avoid further episodes of cholangitis. Unfortunately, the patient refused either surgical or more conservative treatment and was lost to follow-up.
authors.affiliation: Interdisciplinary Center for Biomedical Research (CIR), Laboratory of Internal Medicine and Hepatology, University Campus Bio-Medico, Rome, Italy.
authors.forename: Enrico Maria
authors.initials: EM
authors.lastname: Zardi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Malafarina
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ambrosino
authors.forename: Valentina
authors.initials: V
authors.lastname: Uwechie
authors.forename: Massimo
authors.initials: M
authors.lastname: Rollo
authors.forename: Antonio
authors.initials: A
authors.lastname: Picardi
authors.forename: Antonella
authors.initials: A
authors.lastname: Afeltra
authors.forename: Franco
authors.initials: F
authors.lastname: Lumachi
mesh_terms: D001649:Bile Duct Diseases / Q000175:diagnosis / Q000209:etiology; D017734:Bile Ducts, Extrahepatic / Q000473:pathology*; D002761:Cholangitis / Q000188:drug therapy / Q000209:etiology*; D001651:Cholestasis, Extrahepatic / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications*