Alshwayyat Sakhr, Hanifa Hamdah, Alshwaiyat Yamen, Alshwayyat Mustafa, Alhussein Hussein, Abu-Naja Malak, Alshwayyat Tala Abdulsalam, Alsaleh Basil, Shafa'a Mohammad, Alkurdi Muhammad Fadi
Research Associate, King Hussein Cancer Center, Amman, Jordan.
Internship, Princess Basma Teaching Hospital, Irbid, Jordan.
Int J Emerg Med. 2025 Mar 3;18(1):43. doi: 10.1186/s12245-025-00859-7.
Adenocarcinoma of the distal common bile duct (CBD) is a rare and aggressive malignancy that is often diagnosed at an advanced stage owing to nonspecific symptoms and delayed presentation. This case report details the diagnostic and therapeutic challenges associated with distal CBD adenocarcinoma and highlights the need for an effective multidisciplinary approach.
A 54-year-old male with a significant smoking history presented with persistent right upper abdominal pain, dark urine, and scleral jaundice. Imaging studies revealed intrahepatic bile duct dilatation, a mass obstructing the common bile duct, and thickened gallbladder walls. Despite initial antibiotic therapy for suspected cholangitis, the patient underwent endoscopic retrograde cholangiopancreatography (ERCP) and subsequently a surgical procedure. The surgical resection of a common bile duct adenocarcinoma with lymphovascular invasion was successful, with subsequent restoration of bile flow through Roux-en-Y hepaticojejunostomy. Histopathological analysis confirmed tumor characteristics and clear surgical margins. Postoperatively, the patient demonstrated significant clinical improvement with normalized bilirubin levels and received appropriate management for his oncologic condition.
This case highlights the diagnostic complexity of distal CBD adenocarcinoma, particularly in patients with delayed symptoms. Multimodal imaging approaches and timely surgical intervention are crucial for effective management of this malignancy. Enhanced awareness of atypical presentations and advancements in targeted therapies holds promise for improving outcomes in such challenging cases.
远端胆总管腺癌是一种罕见且侵袭性强的恶性肿瘤，由于症状不特异且就诊延迟，常于晚期才被诊断出来。本病例报告详细阐述了与远端胆总管腺癌相关的诊断和治疗挑战，并强调了采取有效多学科方法的必要性。
一名有大量吸烟史的54岁男性，出现持续右上腹疼痛、深色尿液和巩膜黄疸。影像学检查显示肝内胆管扩张、胆总管有肿物梗阻以及胆囊壁增厚。尽管最初对疑似胆管炎进行了抗生素治疗，但患者仍接受了内镜逆行胰胆管造影术（ERCP），随后进行了手术。成功切除了伴有淋巴管侵犯的胆总管腺癌，随后通过Roux-en-Y肝空肠吻合术恢复了胆汁流动。组织病理学分析证实了肿瘤特征且手术切缘清晰。术后，患者胆红素水平恢复正常，临床症状显著改善，并针对其肿瘤病情接受了适当治疗。
本病例突出了远端胆总管腺癌的诊断复杂性，尤其是对于症状出现较晚的患者。多模态成像方法和及时的手术干预对于有效治疗这种恶性肿瘤至关重要。提高对非典型表现的认识以及靶向治疗的进展有望改善此类具有挑战性病例的治疗效果。
