Ann Hepatobiliary Pancreat Surg.  2019 Aug;23(3):282-285. 10.14701/ahbps.2019.23.3.282.

Traumatic bile duct neuroma presenting with acute cholangitis: A case report and review of literature

Affiliations
  • 1Department of General Surgery, Harbor-UCLA Medical Center, Torrance, CA, USA. kchen6@dhs.lacounty.gov
  • 2Department of Internal Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA.
  • 3Department of Pathology, Harbor-UCLA Medical Center, Torrance, CA, USA.

Abstract

Traumatic neuroma of the biliary tree has been previously reported as isolated case reports. In literature, these typically present following prior liver transplant or cholecystectomy, wherein the bile ducts have been disrupted in some form. Here we report the case of a 41-year old male who initially presented with acute cholangitis ten years after an open cholecystectomy complicated by a bile leak. Endoscopic retrograde cholangiography revealed a stricture within the mid distal common hepatic duct. The patient temporarily resolved his initial episode with stent placement, and he was eventually taken to the operating room for bile duct resection and hepaticojejunostomy given a persistent stricture and concern for underlying malignancy. Final pathology demonstrated a traumatic bile duct neuroma. This unusual entity should be considered in patients with benign appearing strictures presenting years after surgery, and awareness may aid in preoperative counseling as well.

Keyword

Bile duct neuroma; Biliary stricture; Biliary obstruction

MeSH Terms

Bile Ducts*
Bile*
Biliary Tract
Cholangiography
Cholangitis*
Cholecystectomy
Constriction, Pathologic
Counseling
Hepatic Duct, Common
Humans
Liver
Male
Neuroma*
Operating Rooms
Pathology
Stents

Figure

  • Fig. 1 ERCP showing common bile duct stricture.

  • Fig. 2 Histopathology of traumatic bile duct neuroma. (A) Section of the distal common bile duct showing a haphazard arrangement of nerves (arrows) surrounding the duct (H&E, 80× magnification). No neoplasm is seen. (B) Higher magnification of the nerves (H&E, 200×). (C) The nerves stain positively for S-100 (40× magnification).


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