Challenges in diagnosing and treating distal common bile duct adenocarcinoma: A case report with literature insights

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.