ABSTRACT
An intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is an uncommon tumor characterized by the secretion of large amounts of mucin and intraductal growth. The characteristic clinical symptoms and radiologic findings are due to bile-duct obstruction caused by mucin. A parapapillary choledochoduodenal fistula is a rare disorder. This fistula has no clinical symptoms and is diagnosed by chance. We report a case of parapapillary choledochoduodenal fistula associated with IPMN-B. A 63-year-old woman was admitted to Hanyang University Hospital because of jaundice. Computed tomography (CT) showed diffuse intra- and extrahepatic bile duct dilatation. The ducts were filled with heterogenous material. Duodenoscopy revealed a large choledochoduodenal fistula. Endoscopic retrograde cholangiography through the fistula showed a papillary mass in the common hepatic duct. IPMN-B with choledochoduodenal fistula was diagnosed. The patient underwent a left hepatectomy. Her postoperative course was uneventful, and she was observed regularly in the outpatient department.
Subject(s)
Female , Humans , Middle Aged , Bile , Bile Ducts , Bile Ducts, Extrahepatic , Biliary Fistula , Cholangiography , Dilatation , Duodenoscopy , Fistula , Hepatectomy , Hepatic Duct, Common , Jaundice , Mucins , OutpatientsABSTRACT
An intraductal papillary mucinous neoplasm of the bile ducts (IPMN-B) is an uncommon tumor characterized by the secretion of large amounts of mucin and intraductal growth. The characteristic clinical symptoms and radiologic findings are due to bile-duct obstruction caused by mucin. A parapapillary choledochoduodenal fistula is a rare disorder. This fistula has no clinical symptoms and is diagnosed by chance. We report a case of parapapillary choledochoduodenal fistula associated with IPMN-B. A 63-year-old woman was admitted to Hanyang University Hospital because of jaundice. Computed tomography (CT) showed diffuse intra- and extrahepatic bile duct dilatation. The ducts were filled with heterogenous material. Duodenoscopy revealed a large choledochoduodenal fistula. Endoscopic retrograde cholangiography through the fistula showed a papillary mass in the common hepatic duct. IPMN-B with choledochoduodenal fistula was diagnosed. The patient underwent a left hepatectomy. Her postoperative course was uneventful, and she was observed regularly in the outpatient department.