(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: A 58-year-old male patient came to the clinic with yellow skin for half a month. Intensive abdominal CT revealed a tumor in the middle part of the common bile duct and recommended surgical resection, to which the patient agreed. Choledochotomy was given and intraoperative pathology suggested bile duct adenoma, a benign tumor, followed by bile duct jejunostomy. The operation went smoothly and the lesion was completely resected. The patient’s jaundice subsided and all indexes gradually returned to normal.
Basic information】Male, 58 years old
Disease Type】Biliary adenoma
Hospital】Liaocheng People’s Hospital
Date of consultation】November 2021
Treatment plan】Surgical treatment (common bile duct resection + bile duct jejunostomy)
Treatment Period】7 days of hospitalization, returned to hospital on the 9th day after surgery to remove stitches
Treatment effect】The lesion was completely removed, jaundice subsided, and all indicators gradually returned to normal.
I. Initial consultation
When we first saw the patient, his skin was very yellow, which was a manifestation of jaundice. The patient said that his body had been yellow for half a month, and his urine had been yellow for a long time, and he had a poor appetite without fever or nausea. The patient was routinely given liver function tests in the outpatient clinic, which indicated that transaminases, bilirubin and transpeptidase were significantly elevated, a manifestation of obstructive jaundice, suggesting the presence of biliary obstruction.
II. Treatment history
After admission, the patient was given an intensive CT examination, and a tumor of about 1 cm in diameter was seen in the middle segment of the common bile duct, with significant enhancement in the arterial phase, dilated intrahepatic bile ducts, and distended gallbladder, and no obvious contraindication to surgery was seen in the examination of cardiopulmonary function. The need for surgery and the risk of surgery were explained to the patient’s family, and the patient agreed to the surgical treatment. The patient underwent choledochotomy under general anesthesia, and sent a rapid pathological examination, which indicated bile duct adenoma, and there was no tumor residue on the upper and lower margins, indicating that the patient’s tumor was benign and did not need to be enlarged.
III. Treatment effect
The patient started to get out of bed on the second day after surgery, and started to eat liquid diet on the third day after surgery. Postoperative recheck of liver function indicated that transaminases and bilirubin gradually decreased, and the patient’s yellowish skin symptoms also gradually improved and turned into normal color. The patient’s abdominal CT was repeated on the 5th postoperative day, and there was no obvious fluid accumulation in the abdominal cavity, and the surgical area was very clean and discharged on the 7th day of hospitalization. In addition, routine postoperative pathology also suggested bile duct adenoma, with no obvious signs of malignancy.
IV. Notes
We are glad that the patient underwent surgery to remove the tumor. The patient was reminded to return to the hospital on the 9th day after surgery to remove the stitches, and to pay attention to a light diet, avoiding spicy, stimulating and oily food, and gradually increasing the amount of food and nutrition. The liver function should be rechecked 2 weeks after discharge to see if the bilirubin and transaminases have completely decreased to normal, and the abdominal CT should be rechecked to see if there is any abdominal infection and fluid in the abdominal cavity. Because the patient has benign tumor and radical resection, so if there is no discomfort, the patient can not need to have long-term reexamination. However, if symptoms such as abdominal distension, fever, jaundice, anorexia, indigestion, etc. occur, timely review should also be performed.
V. Personal insight
Bile duct tumors can be divided into benign tumors and malignant tumors. At present, the incidence of malignant tumors in bile ducts is high, while the incidence of benign tumors is low. The patient today is lucky, the pathology confirmed that it is bile duct adenoma, which is a benign tumor, and the surgical result is very good, and it usually does not recur after surgical removal, so there is no need for long-term review.