The Mount Sinai Journal of Medicine

 

Volume 73 Number 8
December 2006		 back to contents
An Unusual Post-traumatic Case of Extrahepatic Bile Duct Compression 1093–1094
Enrico Maria Zardi, M.D.1, Vincenzo Malafarina, M.D.1, Giovanni Ambrosino, M.D.2, Valentina Uwechie, M.D.1, Massimo Rollo, M.D.3, Antonio Picardi, M.D.1, Antonella Afeltra, M.D.1, and Franco Lumachi, M.D.2

1Interdisciplinary Center for Biomedical Research (CIR), Laboratory of Internal Medicine and Hepatology, University Campus Bio-Medico, Rome, Italy; 2Department of Surgical and Gastroenterological Sciences, University of Padua, Italy; and 3Institute of Radiology, Università Cattolica del S. Cuore, Policlinico Gemelli, Rome, Italy.

Address all correspondence to Dr. Franco Lumachi, Department of Surgical and Gastroenterological Sciences, University of Padua, School of Medicine, via Giustiniani 2, 35128 Padova, Italy; e-mail: flumachi@unipd.it

Accepted for publication May 2006.

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.

Key Words

Bile duct compression, abdominal trauma, renal cysts

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