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Updated: Jun 20, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
A pediatric case of Burkitt's lymphoma with bile duct obstruction requiring surgical biliary reconstruction
Shun Watanabe1,2, Kan Suzuki3,4, Kei Ogino3,4
1Department of Surgical Oncology, Graduate School of Medicine, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Shimotsuga, Tochigi, 321-0293, Japan. shun-wat@dokkyomed.ac.jp.
Insights
Biliary reconstruction surgery effectively treated obstructive jaundice in a pediatric lymphoma case. This approach offers long-term biliary patency for pediatric patients with stent-dependent biliary obstruction.
Area of Science:
- Pediatric Oncology
- Surgical Gastroenterology
Background:
- Biliary obstruction from B-cell solid tumors is rare.
- Malignant lymphoma can cause obstructive jaundice, particularly in children.
- Previous reports on biliary reconstruction for lymphoma-induced jaundice are limited, especially in pediatric cases.
Purpose of the Study:
- To report a pediatric case of obstructive jaundice caused by malignant lymphoma.
- To evaluate the efficacy of biliary reconstruction surgery in a pediatric patient with lymphoma-induced biliary obstruction.
Main Methods:
- A 5-year-old girl with a massive abdominal tumor causing biliary stricture underwent chemotherapy and endoscopic biliary stent placement.
- The patient required repeated stent replacements over 9 months due to persistent biliary obstruction.
- Choledochojejunostomy and retrocolic Roux-en-Y reconstruction were performed after 15 months due to stent-dependent obstruction.
Main Results:
- Complete tumor remission was achieved with chemotherapy.
- The patient developed stent-dependent biliary obstruction requiring surgical intervention.
- Biliary reconstruction resulted in no postoperative complications, tumor recurrence, and maintained low bilirubin levels.
- Histopathology revealed fibrotic and thickened bile duct walls with lumen narrowing.
Conclusions:
- Biliary reconstruction surgery is effective for achieving long-term biliary patency in pediatric patients with stent-dependent biliary obstruction secondary to malignant lymphoma.
- The optimal timing for transitioning from biliary stent replacement to surgical reconstruction remains a subject for further investigation.
- Additional case studies are needed to refine management strategies for this rare condition.
Background:
Biliary obstruction due to compression by a B-cell solid tumor occurs rarely. A few reports have described biliary reconstruction surgery for obstructive jaundice caused by Burkitt's lymphoma. However, there are no detailed reports on pediatric cases. We report a pediatric case of obstructive jaundice due to malignant lymphoma treated with biliary reconstruction surgery.
Case Presentation:
A 5-year-old girl presented to our hospital with a massive abdominal tumor that caused biliary stricture. Chemotherapy was initiated after an open tumor biopsy. However, endoscopic biliary stent placement was performed owing to elevated bilirubin levels. We treated the patient with chemotherapy for 9 months while endoscopically replacing the biliary stent every few months. She achieved complete tumor remission. However, sclerotic lymph nodes were persistent on the dorsal side of the cholecystic duct junction, and biliary stricture at the same site had changed to stent-dependent biliary obstruction. Therefore, we performed choledochojejunostomy and retrocolic Roux-en-Y reconstruction 15 months after initial admission. There were no postoperative complications or tumor recurrences, and the bilirubin level remained low. Histopathologically, the resected bile duct wall was fibrotic and thick, and the bile duct lumen narrowed.
Conclusions:
Biliary reconstruction is effective to achieve long-term biliary patency in pediatric patients with stent-dependent biliary obstruction due to malignant lymphoma. However, the decision on when to stop biliary stent replacement and proceed to biliary reconstruction surgery is a matter of debate. Further case studies are required to address this issue.
