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Biliary Papillomatosis - A Rare Cause of Recurrent Cholangitis and Biliary Obstruction

¹Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Level 5 Academia, 20 College Road, Singapore

²Department of Gastroenterology and Hepatology, Singapore General Hospital, Level 5 Academia, 20 College Road, Singapore

*Corresponding Author:

Kam Juinn Huar
Associate Consultant
Department of HPB and
Transplant Surgery SingaporeGeneral Hospital
Level 5 Academia 20 College Road, Singapore
Tel: 6563265563
Fax: 6562209323
E-mail: kam.juinn.huar@sgh.com.sg

Received date: March 12, 2015, Accepted date: March 13, 2015, Published date: March 20, 2015

Citation: Huar KJ, Yip CC, Christopher KJL, Damien TMY (2015) Biliary Papillomatosis - A Rare Cause of Recurrent Cholangitis and Biliary Obstruction. J Gastrointest Dig Syst 5:I103. doi:10.4172/2161-069X.1000i103

Copyright: © 2015 Haur K et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.

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Medical Image

Biliary papillomatosis is a rare bile duct pathology with papillary adenomatous growth of varying extent involving intra and extrahepatic biliary system. It may present with obstructive jaundice or cholangitis. Biliary imaging may show multiple filling defects. This may be mistaken as multiple biliary stones which often present concomitantly. Biliary papillomatosis is a premalignant condition and surgical resection provides the best form of curative treatment for suitable patients. In our patient, the preoperative histological diagnosis of high grade dysplasia was obtained from ERCP. The papillomatous growth has involved left hepatic duct proximally and distally into ampulla of Vater as shown in MRCP and endoscopy. The patient underwent left hepatectomy and pylorus preserving pancreaticoduodenectomy successfully (Figures 1-4).

Figure 1: T2 weighted MRI showing slightly hyperintense intraductal soft tissue masses that extend into left hepatic duct and distal CBD.

Figure 2: ERCP showing ductal trifurcation and dilated biliary tree with multiple filling defects in the main bile duct that extend into left hepatic duct.

Figure 3: Endoscopy showing papillomatous growth involving ampulla of Vater.

Figure 4: Ductal cholangioscopy showing papillomatous growth within CBD.