Gokul Shanker, MS, DNB, MBA, Anand Bharathan, MS, DNB, Vadiraj Hunnur, MS, Hariprasad Duraisamy, MS. vgm gastro centre
A 52 year old woman presented with abdominal discomfort and jaundice for 1 month. Discomfort was in upper abdomen, did not have any periodicity and was non-radiating. She noticed high colored urine a month ago. There was no pruritus or pale stools. She had low grade, intermittent fever. She reported anorexia and had lost 20 kilogram weight over the last 1 year. There was no gastrointestinal bleeding. Stools were normal. She did not have any comorbidity. She did not undergo any operation in the past. She frequently looked after a cat that was living near her house.
Clinical examination revealed a moderately nourished woman, who was icteric. There were no signs of liver cell failure. There was no supraclavicular lymphadenopathy. Abdomen was not distended and was soft. Non tender hepatomegaly was present. There was no palpable mass. There was no clinical evidence of free fluid in abdomen. Examination of other systems was unremarkable.
Serum bilirubin was 2.6 mg/dl. Conjugated bilirubin was 2 mg/dl and alkaline phosphatase was 560 IU/ml. Ultrasound scan abdomen revealed a complex cystic lesion in segment 4 and 5 of liver with dilatation of intrahepatic biliary radicles bilaterally. CT scan of abdomen revealed a complex cystic lesion in segment 4 and 5 and the same was encroaching the umbilical fissure. A solid component of the lesion extended into the hilar biliary confluence occluding it. There was no vascular invasion or metastatic disease. ERCP did not reveal any hydatid cyst elements in the extrahepatic biliary tree. Preoperative diagnosis was biliary cystadenocarcinoma.
We performed left hepatectomy with segment 5 liver resection with resection of extrahepatic biliary tree and did cholangiojejunostomy to right sided sectoral ducts. Operating time was 8 hours and 30 minutes. Blood loss was 400 ml and we gave 1 unit blood transfusion. Patient recovered uneventfully. Biopsy showed biliary cystadenoma in liver with a solid component extending into hilar biliary confluence and obstructing it.
We intend to show the preoperative imaging, planning of the operation and the operative pictures. The poster intends to show the typical histopathology of hepatobiliary cystadenoma. The histopathology of bile duct solid component would also be illustrated.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78703
Program Number: P448
Presentation Session: Poster (Non CME)
Presentation Type: Poster