Abstract
Background
Intraductal papillary neoplasm of the bile duct (IPNB) or biliary papillomatosis is a precursor lesion of papillary cholangiocarcinoma.1 IPNB is recognized as a biliary counterpart of IPMN (pancreatic intraductal papillary mucinous neoplasm). IPNB is a rare disease involving entire (diffuse type) or one part (localized type) of biliary tree. Patients without distant metastasis are considered for surgical resection. For patients with distal bile duct papillomatosis, pancreaticoduodenectomy (PD) is recommended for patients with invasive distal bile duct IPNB. PD is a high complex procedure associated with the deterioration of endocrine and exocrine functions leading to a significant impact on quality of life.2 Some authors have reported a new surgical approach leading to a complete resection of the common bile duct without pancreatectomy.3
Methods
We report the case of a 71-year-old female presented to our department with jaundice. At endoscopic ultrasound with cholangioscopy and CT scan, 2-cm distal bile duct mass tumor with villous component was seen. All needle biopsies were benign, and no distant disease was found. According to the risk of degeneration of this tumor, a surgical resection was decided.
Results
Intraoperative frozen section assessed the benignity of peripancreatic lymph nodes. We performed surgical ampullectomy with resection of the common bile duct. The intrapancreatic common bile duct was completely mobilized between the ampullectomy area and the upper edge of the pancreas. Frozen sections on distal and proximal margins of common bile duct were performed to discard malignancy. Finally, reconstruction consisted on the main pancreatic duct reimplantation to the duodenum and choledochoduodenostomy. The histological analysis confirmed the diagnosis of biliary papillomatosis with low-grade dysplasia.
Conclusion
This procedure allows complete resection of benign tumors with endobiliary extension and preserve intestinal continuity and pancreatic parenchyma.
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References
Nakajima T, Kondo Y, Miyazaki M, Okui K. A histopathologic study of 102 cases of intrahepatic cholangiocarcinoma: Histologic classification and modes of spreading. Hum Pathol 1988; 19:1228-1234.
Kusakabe J, Anderson B, Liu J, Williams GA, Chapman WC, Doyle MMB et al. Long Term Endocrine and Exocrine Insufficiency after Pancreatectomy. J Gastrointest Surg 2019; 23:1604-1613.
Sauvanet A, Dokmak S, Cros J, Cazals-Hatem D, Ponsot P, Palazzo M. Surgical Ampullectomy with Complete Resection of the Common Bile Duct: a New Procedure for Radical Resection of Non-invasive Ampulloma with Biliary Extension. J Gastrointest Surg 2017; 21:1533-1539.
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Khodr, J., Truant, S. & El Amrani, M. Surgical ampullectomy with resection of the common bile duct for biliary papillomatosis. J Gastrointest Surg 25, 1087–1088 (2021). https://doi.org/10.1007/s11605-020-04851-9
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DOI: https://doi.org/10.1007/s11605-020-04851-9