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Biliary papillomatosis. Case report.

Immacolata Forlano¹, Alberto Fersini, Nicola Tartaglia

¹Department of Surgical Sciences, Division of General Surgery, University of Foggia, Polyclinic Ospedali Riuniti Foggia, Italy.

Annali Italiani Di Chirurgia

|October 13, 2011

Summary

Biliary papillomatosis, a rare condition causing multiple papillary tumors in the bile ducts, presents diagnostic challenges. Early surgical intervention and histological examination are crucial for managing this prolonged disease and preventing potential carcinoma development.

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Area of Science:

Gastroenterology
Hepatobiliary Surgery
Surgical Pathology

Background:

Biliary papillomatosis is a rare biliary pathology characterized by multiple papillary tumors within the intrahepatic and/or extrahepatic biliary tree.
Distinguishing biliary papillomatosis from cholelithiasis poses significant diagnostic challenges due to its rarity and prolonged, often asymptomatic, course.

Observation:

A case of biliary papillomatosis in the common hepatic duct of an 82-year-old male presented with obstructive jaundice and abdominal pain.
Initial management included cholecystectomy and T-tube placement, followed by persistent filling defects in the common bile duct on cholangiography.

Findings:

Surgical resection of the common bile duct and hepaticojejunostomy were performed.
Histological examination revealed a villous adenoma with high-grade dysplasia, confirming the diagnosis of biliary papillomatosis.

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Implications:

This case highlights the diagnostic difficulties and prolonged nature of biliary papillomatosis.
Pre-operative and intra-operative decision-making, including histological examination, is vital for determining the optimal therapeutic strategy (resection, transplantation, or stenting).
Prompt diagnosis and management are essential to prevent the progression of biliary papillomatosis to papillary carcinoma.