Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum
Periampullary duodenal diverticula are not uncommon and are usually asymptomatic although complications may occasionally occur. Here, we report the case of a 72-year-old woman who presented with painless obstructive jaundice. Laboratory tests showed abnormally elevated serum concentrations of total...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2012-07-01
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| Series: | Case Reports in Gastroenterology |
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| Online Access: | http://www.karger.com/Article/FullText/341955 |
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| author | Anastasios J. Karayiannakis Helen Bolanaki Nikos Courcoutsakis Georgios Kouklakis Erchan Moustafa Panos Prassopoulos Constantinos Simopoulos |
| author_facet | Anastasios J. Karayiannakis Helen Bolanaki Nikos Courcoutsakis Georgios Kouklakis Erchan Moustafa Panos Prassopoulos Constantinos Simopoulos |
| author_sort | Anastasios J. Karayiannakis |
| collection | DOAJ |
| description | Periampullary duodenal diverticula are not uncommon and are usually asymptomatic although complications may occasionally occur. Here, we report the case of a 72-year-old woman who presented with painless obstructive jaundice. Laboratory tests showed abnormally elevated serum concentrations of total and direct bilirubin, of alkaline phosphatase, of γ-glutamyl transpeptidase, and of aspartate and alanine aminotransferases. Serum concentrations of the tumor markers carbohydrate antigen 19-9 and carcinoembryonic antigen were normal. Abdominal ultrasonography showed dilatation of the common bile duct (CBD), but no gallstones were found either in the gallbladder or in the CBD. The gallbladder wall was normal. Computed tomography failed to detect the cause of CBD obstruction. Magnetic resonance imaging and magnetic resonance cholangiopancreatography revealed a periampullary diverticulum measuring 2 cm in diameter and compressing the CBD. The pancreatic duct was normal. Hypotonic duodenography demonstrated a periampullary diverticulum with a filling defect corresponding to the papilla. CBD compression by the diverticulum was considered as the cause of jaundice. The patient was successfully treated by surgical excision of the diverticulum. In conclusion, the presence of a periampullary diverticulum should be considered in elderly patients presenting with obstructive jaundice in the absence of CBD gallstones or of a tumor mass. Non-interventional imaging studies should be preferred for diagnosis of this condition, and surgical or endoscopic interventions should be used judiciously for the effective and safe treatment of these patients. |
| first_indexed | 2024-12-23T13:18:29Z |
| format | Article |
| id | doaj.art-0812a24aad0a4ac6a8a12427d56a0e37 |
| institution | Directory Open Access Journal |
| issn | 1662-0631 |
| language | English |
| last_indexed | 2024-12-23T13:18:29Z |
| publishDate | 2012-07-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Gastroenterology |
| spelling | doaj.art-0812a24aad0a4ac6a8a12427d56a0e372022-12-21T17:45:32ZengKarger PublishersCase Reports in Gastroenterology1662-06312012-07-016252352910.1159/000341955341955Common Bile Duct Obstruction Secondary to a Periampullary DiverticulumAnastasios J. KarayiannakisHelen BolanakiNikos CourcoutsakisGeorgios KouklakisErchan MoustafaPanos PrassopoulosConstantinos SimopoulosPeriampullary duodenal diverticula are not uncommon and are usually asymptomatic although complications may occasionally occur. Here, we report the case of a 72-year-old woman who presented with painless obstructive jaundice. Laboratory tests showed abnormally elevated serum concentrations of total and direct bilirubin, of alkaline phosphatase, of γ-glutamyl transpeptidase, and of aspartate and alanine aminotransferases. Serum concentrations of the tumor markers carbohydrate antigen 19-9 and carcinoembryonic antigen were normal. Abdominal ultrasonography showed dilatation of the common bile duct (CBD), but no gallstones were found either in the gallbladder or in the CBD. The gallbladder wall was normal. Computed tomography failed to detect the cause of CBD obstruction. Magnetic resonance imaging and magnetic resonance cholangiopancreatography revealed a periampullary diverticulum measuring 2 cm in diameter and compressing the CBD. The pancreatic duct was normal. Hypotonic duodenography demonstrated a periampullary diverticulum with a filling defect corresponding to the papilla. CBD compression by the diverticulum was considered as the cause of jaundice. The patient was successfully treated by surgical excision of the diverticulum. In conclusion, the presence of a periampullary diverticulum should be considered in elderly patients presenting with obstructive jaundice in the absence of CBD gallstones or of a tumor mass. Non-interventional imaging studies should be preferred for diagnosis of this condition, and surgical or endoscopic interventions should be used judiciously for the effective and safe treatment of these patients.http://www.karger.com/Article/FullText/341955Ampulla of VaterDiverticulumDuodenumComplicationsJaundicePeriampullary |
| spellingShingle | Anastasios J. Karayiannakis Helen Bolanaki Nikos Courcoutsakis Georgios Kouklakis Erchan Moustafa Panos Prassopoulos Constantinos Simopoulos Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum Case Reports in Gastroenterology Ampulla of Vater Diverticulum Duodenum Complications Jaundice Periampullary |
| title | Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum |
| title_full | Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum |
| title_fullStr | Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum |
| title_full_unstemmed | Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum |
| title_short | Common Bile Duct Obstruction Secondary to a Periampullary Diverticulum |
| title_sort | common bile duct obstruction secondary to a periampullary diverticulum |
| topic | Ampulla of Vater Diverticulum Duodenum Complications Jaundice Periampullary |
| url | http://www.karger.com/Article/FullText/341955 |
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