Management of the mucin filled bile duct. A complication of intraductal papillary mucinous tumor of the pancreas

Anand Patel, Louis Lambiase, Antonio Decarli, Ali Fazel

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Context: Biliary obstruction secondary to intrabiliary mucin is a relatively rare presentation of malignant intraductal pancreatic mucinous tumor. We report a case of unresectable intraductal pancreatic mucinous tumor associated with obstructive jaundice secondary to intrabiliary mucin. This case and a review of the literature, highlight the difficulty in obtaining sustained palliation from jaundice using endoscopically placed biliary stents or percutaneously placed biliary catheters due to rapid occlusion with thick mucin secreted by the tumor. Furthermore, this case differs from that commonly seen in the setting of pancreatic adenocarcinoma, where endoscopic or percutaneous biliary drainage is usually successful at long-term palliation from jaundice. Case report: We report a case of obstructive jaundice secondary to invasive intraductal pancreatic mucinous tumor associated with dilated bile ducts containing copious amounts of mucin. The diagnosis of intraductal pancreatic mucinous tumor was established based on diagnostic findings on computed tomography scan and endoscopic retrograde cholangiopancreatography. The tumor was unresectable due to vascular invasion. Attempts at endoscopic biliary drainage proved unhelpful with the patient experiencing rapid occlusion of the biliary stents with thick mucinous material leading to recurrent cholangitis. The patient eventually underwent a choledochojejunostomy leading to complete and sustained resolution of the cholestasis. Conclusion: If intraductal pacreatic mucinous tumor in association with intrabiliary mucinous obstruction is deemed unresectable, surgical biliary bypass seems to be superior to endoscopy biliary drianage and shoul be performed on initial presentation. This is due to rapid occlusion of biliary stents with thick mucin leading to frequent stent changes and recurrent cholestasis.

Original languageEnglish (US)
Pages (from-to)255-259
Number of pages5
JournalJournal of the Pancreas
Volume6
Issue number3
StatePublished - May 1 2005
Externally publishedYes

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Mucins
Bile Ducts
Pancreas
Stents
Neoplasms
Obstructive Jaundice
Cholestasis
Jaundice
Drainage
Choledochostomy
Cholangitis
Endoscopic Retrograde Cholangiopancreatography
Endoscopy
Blood Vessels
Adenocarcinoma
Catheters
Tomography

All Science Journal Classification (ASJC) codes

  • Endocrinology, Diabetes and Metabolism
  • Hepatology
  • Endocrinology

Cite this

Management of the mucin filled bile duct. A complication of intraductal papillary mucinous tumor of the pancreas. / Patel, Anand; Lambiase, Louis; Decarli, Antonio; Fazel, Ali.

In: Journal of the Pancreas, Vol. 6, No. 3, 01.05.2005, p. 255-259.

Research output: Contribution to journalArticle

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