A case report of an ampullary tumor presenting with spontaneous perforation of an aberrant bile duct and treated with total laparoscopic pancreaticoduodenectomy

World Journal of Surgical Oncology

Mehmet Kaplan¹ 

[1] Department of General Surgery, Medical Park Gaziantep Hospital, Gaziantep, Turkey

关键词: Laparoscopy;    Surgery;    Treatment;    Common bile duct;    Duodenal neoplasm;    Pancreatic neoplasm;    Whipple procedure;    Laparoscopic pancreaticoduodenectomy;    Spontaneous bile duct perforation;    Aberrant bile duct;    Bile peritonitis;   

Others  :  827516
DOI  :  10.1186/1477-7819-10-142

 received in 2012-02-29, accepted in 2012-06-25,  发布年份 2012

【 摘 要 】

Background

This case report discusses a patient who presented with bile peritonitis due to spontaneous perforation of an aberrant bile duct that originated in the triangular ligament of the liver. It was associated with an ampullary tumor and treated with total laparoscopic pancreaticoduodenectomy (TLPD).

Case report

A 58-year-old male patient was admitted to the emergency department of Medical Park Gaziantep Hospital in September 2009 with acute abdominal findings. He underwent an urgent laparoscopy, and, interestingly, bile peritonitis due to the rupture of an aberrant bile duct in the triangular ligament was noted. After laparoscopic treatment of the acute conditions, the follow-up examinations of the patient showed the finding of obstructive jaundice. Endoscopic retrograde cholangio-pancreatography revealed a 1-cm polypoid mass located at the ampulla of Vater (duodenal papilla) with possible extension to the ampullary sphincter. A stent was inserted for temporary biliary drainage, and subsequent endoscopic biopsy showed the pathological finding of adenocarcinoma.

After waiting for a 1-month period for the peritonitis to heal, the patient underwent pylorus-preserving TLPD and was discharged without any major complications on postoperative day 7.

Conclusion

In patients with bile peritonitis, it should be considered that the localization of the perforation may be in an aberrant bile duct localized at the triangular ligament and the etiology may be associated with an obstructing periampullary tumor. Laparoscopic pancreaticoduodenectomy is a feasible operative procedure in carefully selected patients. This technique can achieve adequate margins and follows oncological principles. Randomized comparative studies are needed to establish the superiority of minimally invasive surgery over traditional open surgery.

【 授权许可】

   
2012 Kaplan; licensee BioMed Central Ltd.

【 图 表 】

Figure 2.

Figure 3.

【 参考文献 】

• [1]Davenport M, Heaton ND, Howard ER: Spontaneous perforation of the bile duct in infants. Br J Surg 1991, 78:1068-1070.
• [2]Kumar A: Spontaneous perforation of the common bile duct: a rare cause of acute abdomen in adults. Surgery 1998, 124:924-925.
• [3]Ho Seong H, Soeg Ki M, Hyeon Kook L, Sung Bum Kang: Nontraumatic Perforation of Bile Duct in Adults. Arch Surg 2004, 139:1083-1087.
• [4]Fujiwara H, Yamamoto M, Takahashi M, Ishida H, Ohashi O, Onoyama H, Takeyama Y, Kuroda Y: Spontaneous rupture of an intrahepatic bile duct with biloma treated by percutaneous drainage and endoscopic sphincterotomy. Am J Gastroenterol 1998, 93:2282-2284.
• [5]Trivedi PJ, Gupta P, Phillips-Hughes J, Ellis A: Biloma: An unusual complication in a patient with pancreatic cancer. World J Gastroenterol 2009, 15:5218-5220.
• [6]Megison SM, Votteler TP: Management of common bile duct obstruction associated with spontaneous perforation of the biliary tree. Surgery 1992, 111:237-239.
• [7]Gundara JS, Jancewicz S: Spontaneous biliary peritonitis, or delayed bile leak? Int J Surg Case Rep 2011, 2:7166-7167.
• [8]Yaşar NF, Yaşar B, Kebapçı M: Spontaneous common bile duct perforation due to chronic pancreatitis, presenting as a huge cystic retroperitoneal mass: a case report. Cases Journal 2009, 2:6273-6275.
• [9]Brady RRW, McAteer E, Weir CD: Biliscrotum and retroperitoneal biloma: spontaneous rupture of the biliary system presenting as an incarcerated inguinal hernia. Ulster Med J 2006, 75:85-87.
• [10]Champetier J, Davin JL, Letoublon C, Laborde Y, Yver R, Cousset F: Aberrant biliary ducts (vasa aberrantia): Surgical implications. Anat Clin 1982, 4:137-145.
• [11]Mascarenhas R, Varadarajan R, Mathias J, Traynor O, Geoghegan J: Accessory left biliary duct draining into the lesser curve of the stomach. Gut 2002, 51:884.
• [12]Kekis PB, Kordonis A, Stamou KM, Kekis BP: Surgical importance of aberrant bile ducts in the left triangular ligament of the liver. HPB 2000, 2:21-24.
• [13]Iso Y, Kusaba I, Matsumata T, Okita K, Murakami N, Nozoe T, Funahashi S, Adachi Y, Yoh R, Sugimachi K: Postoperative bile peritonitis caused by division of an aberrant bile duct in the left triangular ligament of the liver. Am J Gastroenterol 1996, 91:2428-2430.
• [14]Gumbs AA, Rodriguez Rivera AM, Milone L, Hoffman JP: Laparoscopic pancreaticoduodenectomy: a review of 285 published cases. Ann Surg Oncol 2011, 18:1335-1341.
• [15]Briggs CD, Mann CD, Irving GR, Neal CP, Peterson M, Cameron IC, Berry DP: Systematic review of minimally invasive pancreatic resection. J Gastrointest Surg 2009, 13:1129-1137.
• [16]Patterson EJ, Gagner M, Salky B, Inabnet WB, Brower S, Edye M, Gurland B, Reiner M, Pertsemlides D: Laparoscopic pancreatic resection: Single institution experience of 19 patients. J Am Coll Surg 2001, 193:281-287.
• [17]Duluq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A: Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc 2005, 19:1028-1034.
• [18]Palanivelu C, Rajan PS, Rangarajan M, Vaithiswaran V, Senthilnathan P, Parthasarathi R, Praveen Raj P: Evolution in techniques of laparoscopic pancreaticoduodenectomy: a decade long experience from a tertiary center. J Hepatobiliary Pancreat Surg 2009, 16:731-740.