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Repeated obstructive jaundice and acute pancreatitis caused by metastatic liver tumor: an unusual case
Takashi Kobayashi1, Masatoshi Makuuchi, Keiji Sano
1Department of Surgery, Showa General Hospital, Tokyo, Japan. ta-koba@mb.kcom.ne.jp
Abstract:
A case of repeated obstructive jaundice and acute pancreatitis caused by mucus plug produced by metastatic liver tumor is reported. A 74-year-old woman, who had a past history of curative resection of mucinous rectal cancer, showed repeated obstructive jaundice and acute pancreatitis during the follow-up period. Neither computed tomographic scan nor abdominal ultrasound could detect the recurrent lesion, however, cholangioscopy detected mucin and tumor projection into the left hepatic duct. Since the biopsy specimen of the tumor revealed adenocarcinoma, left hepatectomy was performed. The tumor was mucinous adenocarcinoma having the same histology as the primary rectal cancer, with partly mucosal replacement and formation of intraluminal mucus plaque. This case indicates that repeated obstructive jaundice and acute pancreatitis should be considered one of the manifestations of liver metastasis of mucinous cancer.
Insights
Metastatic liver tumors can cause obstructive jaundice and pancreatitis by forming mucus plugs. This case highlights liver metastasis of mucinous cancer as a cause of these conditions.
Area of Science:
- Gastroenterology and Hepatology
- Oncology
Background:
- Recurrent obstructive jaundice and acute pancreatitis can present diagnostic challenges.
- Liver metastases from mucinous rectal cancer require careful monitoring post-resection.
Observation:
- A 74-year-old woman with a history of rectal cancer experienced recurrent obstructive jaundice and pancreatitis.
- Standard imaging (CT, ultrasound) failed to identify the recurrent lesion.
- Cholangioscopy revealed mucin and tumor in the left hepatic duct.
Findings:
- Biopsy confirmed adenocarcinoma, consistent with primary rectal cancer histology.
- Surgical resection revealed a mucinous adenocarcinoma forming an intraluminal mucus plaque.
- The tumor originated from liver metastasis of the primary mucinous rectal cancer.
Implications:
- Obstructive jaundice and acute pancreatitis can be presenting symptoms of liver metastasis from mucinous cancers.
- Cholangioscopy is a valuable tool for diagnosing biliary obstruction when conventional imaging is inconclusive.
- This case underscores the importance of considering metastatic disease in patients with a history of mucinous cancer presenting with biliary complications.
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