Non-MalIg(G4)nant Biliary Obstruction: When the Pill Is Mightier than the Knife
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Case Presentation and Evolution
A 48-year-old man was initially evaluated in a community hospital with jaundice and elevated liver enzymes (bilirubin 9.1 mg/dL and alkaline phosphatase of 682 U/L). Intrahepatic ductal dilatation had been diagnosed with computed tomography (CT); endoscopic retrograde cholangiopancreatography (ERCP) confirmed this and documented a common bile duct stricture which was stented. Pathology from the brushings indicated cellular atypia but no clear evidence of malignancy. He developed post-procedural pancreatitis and a pancreatic pseudocyst that required prolonged drainage, delaying for several months further evaluation of his common bile duct stricture. Once the pancreatic inflammation had subsided, diagnostic laparoscopy was considered in order to further characterize the etiology of his stricture; however, the operation was aborted as it was felt that the patient had extensive cholangiocarcinoma.
KeywordsBile Duct Cholangiocarcinoma Steroid Therapy Primary Sclerosing Cholangitis Obstructive Jaundice
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