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Abstract: The patient, a 66-year-old female, presented to the hospital with generalized yellowing for half a month, liver function suggestive of obstructive jaundice, and an intensive abdominal CT examination suggestive of a mass in the hilar region. After communication regarding her condition, the patient was admitted to the hospital and underwent resection of a bile duct tumor in the hilar region. Rapid intraoperative pathology suggested bile duct adenoma, which was benign in nature. The patient’s adverse symptoms disappeared after surgery, and she recovered well and was discharged from the hospital.
Basic information】Female, 66 years old
Disease Type】Bile duct obstruction, obstructive jaundice, bile duct adenoma
Hospital】Liaocheng People’s Hospital
Date of Consultation】November 2021
Treatment plan】Surgical treatment (resection of hepatoportal bile duct lesion + bile-intestinal anastomosis) + medication (injectable penicillin sodium + glycopyrrolate diamine injection + ursodeoxycholic acid capsule)
Treatment period】Inpatient treatment for 1 week, postoperative review for 1 month
Treatment effect】Intraoperative tumor suggested benign tumor, surgical radical resection, disease cure
I. Initial consultation
The patient visited the clinic in November 2021 and reported yellowing of the body for half a month, very yellow urine, the color of strong tea, a little white stool, and poor appetite, but no fever and no too obvious change in body weight. After liver function tests were done on the patient, the report suggested that transaminases and bilirubin were elevated and it was a state of obstructive jaundice; after performing an abdominal ultrasound, it was found that there was a tumor in the hilar region of the liver, causing bile duct obstruction and bile duct dilation. Based on the patient’s condition and examination results, the first consideration was bile duct tumor, and the patient was admitted to the hospital.
After admission, the patient underwent tumor marker examination and found that CA199 and CEA were within the normal range; intensive CT examination of the abdomen revealed a tumor of about 3 cm in diameter with marked enhancement, bile duct obstruction, and dilated intrahepatic bile duct at the confluence of the bile duct and bile cyst duct in the hilar region. The tumor was still considered to be a bile duct tumor, and the possibility of malignancy was high according to experience.
II. Treatment history
According to the examination results, no distant metastasis or local invasion was found, and the preferred treatment option was surgical resection. After communicating with the patient and family about the condition and treatment plan, the patient agreed to undergo surgical treatment. The patient then underwent resection of the bile duct lesion in the hepatoportal area + bile-intestinal anastomosis under general anesthesia. The intraoperative tumor was seen to be soft in texture and not like a typical malignant tumor. After the operation, he was routinely given anti-infection with injectable penicillin sodium, liver protection with glycyrrhizic acid diamine injection, and bile relief with ursodeoxycholic acid capsule.
III. Treatment effect
The patient was very lucky, because the tumor was benign in nature and no peripheral lymph node dissection was done, so the surgery was relatively less invasive. The patient was able to get out of bed on the 3rd day after surgery, and could start eating after defecation. Before discharge, patients are advised to return to the hospital for a follow-up examination about 1 month after surgery, and if there are no special circumstances, they may not be reviewed later.
IV. Notes
We are glad that the patient recovered after the active treatment. After discharge from the hospital, pay attention to personal hygiene and cleanliness, especially at the incision area, to avoid infection. In terms of diet, pay attention to increase nutrition, you can appropriately eat more high-protein food, such as eggs, milk, etc.; in life, pay attention to more rest and avoid strenuous activities to promote the healing of the incision. At the same time, pay attention to physical changes, if there is fever and other abnormalities, you should go to the hospital in time.
V. Personal insight
The incidence of bile duct tumors is increasing, most of them are malignant tumors, the chance of benign tumors is very small, but the final diagnosis should rely on pathological diagnosis. No matter benign or malignant tumor, it may cause biliary obstruction, so surgery is preferred. In this case, biliary obstruction was also caused by biliary tumor. After resection of biliary tumor, the pathology confirmed that the tumor was benign and the patient recovered to health.