Challenging differential diagnosis, Rare disease, Educational Purpose (only if useful for a systematic review or synthesis)
Jenn-Yuan Kuo, Yeun Tarl Fresner Ng Jao
(Department of Gastroenterology, Tainan Municipal Hospital, Tainan, Taiwan)
Am J Case Rep 2014; 15:466-470
Biliary papillomatosis (BP) with sole involvement of the gall bladder or gall bladder papillomatosis (GBP) is very rare. Biliary-enteric fistula, particularly the cholecystocolonic fistula (CCF) type, is also very rare. The combination of both types of lesions in a single patient has never previously been reported in the English literature.
Case Report: We report herein the case of an 81-year-old woman who was diagnosed with both disease entities, which occurred in a cause-and-effect relationship. She underwent resection of the gall bladder with closure of the fistula, and was discharged improved afterwards.
Conclusions: GBP is a premalignant condition that warrants extensive resection. An absent Murphy’s sign or jaundice on physical examination should not rule out this disease or accompanying biliary tract infection because a biliary-enteric fistula may be present. Thorough review of the radiologic images should be performed, since subtle details could be easily missed or dismissed, thus affecting the postoperative course. A CCF should alert the physician that another disease entity is present.
Keywords: Biliary Fistula - diagnosis, Aged, 80 and over, Cholangiopancreatography, Endoscopic Retrograde, Colonic Diseases - diagnosis, Diagnosis, Differential, Female, Gallbladder, Gallbladder Neoplasms - diagnosis, Humans, Intestinal Fistula - diagnosis, Papilloma - diagnosis, Tomography, X-Ray Computed