Presentation
Upper abdominal pain, jaundice and vomiting. No fever.
Patient Data
Stone and sludge in the gallbladder without any sonographic features of acute cholecystitis. Moderate intra and extra-hepatic biliary dilatation with visualised CBD measuring 15 mm. No filling defect or calculus is seen in the visualised CBD.
Soft tissue density mass lesion in the second and third part of the duodenum, with moderate intra- and extra-hepatic biliary dilatation. Dilated CBD is traceable up to its opening in the duodenum. No clear fat plane is seen between the duodenal mass and pancreas. No significant locoregional lymphadenopathy is seen.
Status post cholecystectomy. No suspicious focal hepato-splenic pathology is seen. A small splenule is seen adjacent to the splenic hilum. Morphology of the pancreas, adrenals and both kidneys is normal. No ascites, collection or significant abdominopelvic lymphadenopathy is seen. Lung bases are clear. No suspicious osseous pathology is seen in the visualised skeleton.
Histopathology of the duodenal mass biopsy showed moderately differentiating adenocarcinoma.
Case Discussion
The patient underwent laparoscopic cholecystectomy after the ultrasound examination. Due to persistence jaundice after cholecystectomy, ERCP (images not available) was done to exclude the possibility of a stone in the distal CBD. No stone was found in the CBD on ERCP; however, a mass lesion was discovered in the duodenum which was biopsied. After the histopathological confirmation of the malignancy, the patient was referred to the general surgeon for further management; however, he lost follow up.
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