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Double rarity: malignant masquerade biliary stricture in a situs inversus totalis patient

BACKGROUND: Situs inversus totalis is a rare anatomical variation of both the thoracic and the abdominal organs. Common bile duct strictures can be caused by malignant and benign diseases as well. 7–18% of the latter ones are 'malignant masquerade’ cases, as pre-operative differentiation is dif...

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Autores principales: Eitler, K., Mathe, Z., Papp, V., Zalatnai, A., Bibok, A., Deak, P. A., Kobori, L., Telkes, G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981884/
https://www.ncbi.nlm.nih.gov/pubmed/33743673
http://dx.doi.org/10.1186/s12893-021-01155-w
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author Eitler, K.
Mathe, Z.
Papp, V.
Zalatnai, A.
Bibok, A.
Deak, P. A.
Kobori, L.
Telkes, G.
author_facet Eitler, K.
Mathe, Z.
Papp, V.
Zalatnai, A.
Bibok, A.
Deak, P. A.
Kobori, L.
Telkes, G.
author_sort Eitler, K.
collection PubMed
description BACKGROUND: Situs inversus totalis is a rare anatomical variation of both the thoracic and the abdominal organs. Common bile duct strictures can be caused by malignant and benign diseases as well. 7–18% of the latter ones are 'malignant masquerade’ cases, as pre-operative differentiation is difficult. CASE PRESENTATION: We present the case of a 68y male patient with known situs inversus totalis and a recent onset of obstructive jaundice caused by a malignant behaving common bile duct stricture. Technically difficult endoscopic retrograde cholangiopancreatography, brush cytology, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and percutaneous transhepatic drainage with stent implantation were performed for proper diagnosis. Cholecystectomy, common bile duct resection with hilar lymphadenectomy, and hepatico-jejunostomy have been performed following multidisciplinary consultation. The final histology report did not confirm any clear malignancy, the patient is doing well. CONCLUSION: In situs inversus patients, both diagnostic and therapeutic procedures can lead to various difficulties. Benign biliary strictures are frequently misdiagnosed preoperatively as cholangiocellular carcinoma. Surgery is usually unavoidable, involving a significant risk of complications. The co-existence of these two difficult diagnostic and therapeutic features made our case challenging. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12893-021-01155-w.
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spelling pubmed-79818842021-03-22 Double rarity: malignant masquerade biliary stricture in a situs inversus totalis patient Eitler, K. Mathe, Z. Papp, V. Zalatnai, A. Bibok, A. Deak, P. A. Kobori, L. Telkes, G. BMC Surg Case Report BACKGROUND: Situs inversus totalis is a rare anatomical variation of both the thoracic and the abdominal organs. Common bile duct strictures can be caused by malignant and benign diseases as well. 7–18% of the latter ones are 'malignant masquerade’ cases, as pre-operative differentiation is difficult. CASE PRESENTATION: We present the case of a 68y male patient with known situs inversus totalis and a recent onset of obstructive jaundice caused by a malignant behaving common bile duct stricture. Technically difficult endoscopic retrograde cholangiopancreatography, brush cytology, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and percutaneous transhepatic drainage with stent implantation were performed for proper diagnosis. Cholecystectomy, common bile duct resection with hilar lymphadenectomy, and hepatico-jejunostomy have been performed following multidisciplinary consultation. The final histology report did not confirm any clear malignancy, the patient is doing well. CONCLUSION: In situs inversus patients, both diagnostic and therapeutic procedures can lead to various difficulties. Benign biliary strictures are frequently misdiagnosed preoperatively as cholangiocellular carcinoma. Surgery is usually unavoidable, involving a significant risk of complications. The co-existence of these two difficult diagnostic and therapeutic features made our case challenging. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12893-021-01155-w. BioMed Central 2021-03-21 /pmc/articles/PMC7981884/ /pubmed/33743673 http://dx.doi.org/10.1186/s12893-021-01155-w Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Eitler, K.
Mathe, Z.
Papp, V.
Zalatnai, A.
Bibok, A.
Deak, P. A.
Kobori, L.
Telkes, G.
Double rarity: malignant masquerade biliary stricture in a situs inversus totalis patient
title Double rarity: malignant masquerade biliary stricture in a situs inversus totalis patient
title_full Double rarity: malignant masquerade biliary stricture in a situs inversus totalis patient
title_fullStr Double rarity: malignant masquerade biliary stricture in a situs inversus totalis patient
title_full_unstemmed Double rarity: malignant masquerade biliary stricture in a situs inversus totalis patient
title_short Double rarity: malignant masquerade biliary stricture in a situs inversus totalis patient
title_sort double rarity: malignant masquerade biliary stricture in a situs inversus totalis patient
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981884/
https://www.ncbi.nlm.nih.gov/pubmed/33743673
http://dx.doi.org/10.1186/s12893-021-01155-w
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