IDDF2018-ABS-0186 Choledochoduodenal fistula in a patient with biliary intraductal papillary mucinous neoplasm

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Abstract

Background

Biliary intraductal papillary mucinous neoplasm (IPMN-B) is an uncommon low malignant tumour of the bile duct. IPMN-B characterised by secreting mucus, biliary obstruction, dilation of the bile duct and has potential to transform to the malignancy. In this study, we may introduce our experiences and summarise the clinicopathological and molecular features of IPMN-B by literature review.

Methods

Here we report the case of a 66-year-old female presented with repeated fever and elevated liver enzymes. Magnetic resonance cholangiopancreatography (MRCP) demonstrated definite cyst tumour and biliary dilatation of common bile duct and hepatic duct (figure 1). Endoscopic retrograde cholangiography (ERC) revealed that the bile duct filled with floating filling-defects and the mucus perforated to duodenal mucosa generating the choledoch duodenal fistula. Due to the poor clinical condition of this patient, we performed biliary plastic stents through the duodenal fistula and transcended the primary mucinous neoplasm to drainage the bile acid. We also summarise the clinicopathological and molecular features of IPMN-B by literature review, which may help to recognise this rare bile duct tumour and improve the clinical diagnosis and treatment decision when encountering the similar series cases.

Results

We successfully relieved biliary obstruction and remitted the elevated liver enzymes and infectious symptoms of this patient by endoscopic therapy. In addition, the patient undergoing the follow-up to monitor the biliary mucinous neoplasm.

Conclusions

Our case demonstrated that patients with IPMN-B or accompany with complications such as the choledochoduodenal fistula, palliative endoscopic drainage may be an effective approach. ERCP is useful for the diagnosis, drainage and decompression of biliary IPMN.

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