Papillary adenoma of the common bile duct: Infrequent pathology, novel endoscopic resolution, rare complication. A case report

Abstract

The presence of papillary adenomatous polypoid lesions in the common bile duct is rare and the cases reported in the literature are associated with bile duct cysts.1 and 2 Because both entities are considered premalignant conditions, they should be resected. Surgical resolution is the usual option and there are few reports on endoscopic management.1 In addition, subcapsular hematoma of the liver and laceration of Glisson's capsule are uncommon complications of endoscopic retrograde cholangiopancreatography (ERCP).3, 4, 5 and 6 We present herein the case of distal bile duct adenoma not associated with biliary tract cysts, resolved through endoscopic polypectomy and complicated by subcapsular hematoma of the liver and Glisson's capsule laceration.

A 78-year-old man had a past history of chronic auricular fibrillation and mitral valve replacement and was under treatment with an anticoagulant (acenocoumarol). He was seen in medical consultation due to nonpainful jaundice of 3-week progression and laboratory tests with a pattern of cholestasis. Abdominal ultrasound showed dilation of the proximal bile duct with an endoluminal image in the distal bile duct. Cholangiography revealed a negative image at the level of the distal bile duct (Fig. 1). Sphincteropapillotomy was performed and a balloon extractor exteriorized a 12 mm pedunculated lesion with a Kudo III mucosal pattern (consistent with adenoma) that was then biopsied. The decision was made to place a 10 Fr plastic biliary stent to ensure drainage and define the therapeutic conduct. The pathologic anatomy study reported papillary adenoma with low-grade dysplasia. The patient progressed with improved cholestasis.