Case report of traumatic bile duct neuroma mimicking cholangiocarcinoma after iatrogenic bile duct injury 13 years ago.

INTRODUCTION AND IMPORTANCE

Neuromas are a nonneoplastic proliferation of Schwann cells around regenerating axons in the peripheral nerves. Traumatic neuromas are rare and can occur in any location of the body.

CASE PRESENTATION

We present a very rare case of traumatic bile duct neuroma in a male patient in his sixth decade who presented with moderate acute cholangitis and jaundice thirteen years after laparoscopic cholecystectomy with iatrogenic common bile duct injury, primary end-to-end biliary anastomosis was made. Radiological studies showed tumour in the common hepatic duct - most likely cholangiocarcinoma Bismuth I without local or distant metastasis, distally to tumour - choledocholithiasis. Endoscopic papillotomy and choledocholithotomy was performed, afterwards cholangitis resolved. The multidisciplinary tumour board meeting decided to perform radical surgical therapy. Open central bile duct resection, lymphadenectomy and hepaticojejunostomy was performed. Postoperative period was without any complications. The final histological diagnosis was traumatic bile duct neuroma most likely after bile duct iatrogenic injury, no malignancy was found.

CLINICAL DISCUSSION

Neuromas typically are asymptomatic, or the symptoms are nonspecific, in a case of extrahepatic biliary neuroma like obstructive jaundice and acute cholangitis, they can be easily mistaken for a cholangiocarcinoma. Only histological evaluation can give the definitive diagnosis.

CONCLUSION

The rarity of bile duct traumatic neuroma renders its diagnosis difficult before the surgery and can even lead to its misdiagnosis as biliary cancer, so the recommended therapy for biliary traumatic neuroma would be surgical resection because one of the possible differential diagnoses is cholangiocarcinoma with poor prognosis without the surgery.