Intrahepatic bile duct rupture associated with IgG4-related sclerosing cholangitis presenting hepatic inflammatory pseudotumor

Okamura, Yusuke; Nishitai, Ryuta; Sasaki, Naoya; An, Hideo; Fushitani, Masashi; Ota, T.; Morioka, Michina; Kawaguchi, Keizaburo; Konishi, Sayuri; Hamasu, Shinya; Manaka, Dai

doi:10.1007/s12328-021-01487-3

Cited by 7 publications

(2 citation statements)

References 13 publications

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“…Другой частой причиной разрыва желчных протоков левой доли печени является аберрантный желчный проток в левой треугольной связке [6]. В представленном обзоре разрыв аберрантного желчного протока левой треугольной связки отмечен в 2 наблюдениях [7,8], а у 8 больных произошел разрыв протоков II-III сегмента печени [6,[9][10][11][12][13][14][15].…”

Section: Abstract: Liver Bile Duct Rupture Spontaneous Perforation He...unclassified

Spontaneous perforation in the bile duct system

Sigua,

Rakita,

Rud

et al. 2023

Ann. hir. gepatol.

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Aim. To evaluate different therapeutic and diagnostic approaches in spontaneous bile duct perforation.Materials and methods. The present study involved the reports on spontaneous perforations in the bile duct system, published from 01.01.2000 to 01.06.2022 and selected by structured search in PubMed/Medline database.Results. As a result, 58 articles describing 71 patients were selected for the study. The most frequent symptoms of the disease included abdominal pain (92.9%), fever (39.4%), and jaundice (33%). The provisional diagnosis was made correctly in 52.1% of cases. The development of the disease was most often associated with choledocholithiasis (38%). Bile ducts perforation of the left hepatic lobe was revealed in 40.6% of cases, perforation of the common bile duct – in 35.5%. Bile duct perforation resulted in peritonitis in 42.2% of patients and bile accumulation or abscess in 30.9%. Encapsulated and intrahepatic accumulation of bile was found in 18.3% of cases. Management of perforations with development of encapsulated and intrahepatic bile accumulation included combined treatment, embracing percutaneous transhepatic drainage and endoscopic methods. Perforation of bile ducts with development of extensive forms of the disease required two-stage treatment. The first stage involved lavage of the abdominal cavity and decompression of the biliary tract. The second stage involved resective and reconstructive surgery to eliminate the cause of the perforation. The mortality rate was 5.6%.Conclusion. Spontaneous perforation in the bile duct system is a rare pathological state appeared as a complication of hepatopancreaticoduodenal diseases. Its management requires greater awareness of abdominal surgeons. The surgical strategy is based on correctly diagnosed and staged treatment tactics, which allows the incidence of complications and mortality rate to be reduced.

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Section: Abstract: Liver Bile Duct Rupture Spontaneous Perforation He...unclassified

Spontaneous perforation in the bile duct system

Sigua,

Rakita,

Rud

et al. 2023

Ann. hir. gepatol.

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“…To our knowledge, this is the first report of a case of abrupt onset and progression of an inflammatory pseudotumor caused by IgG4-RD involving the liver and bile ducts. There have been some reported cases of IgG4-related hepatic inflammatory pseudotumors or IgG4-related sclerosing cholangitis (IgG4-SC) mimicking cholangiocarinoma [ 10 , 11 , 12 ]. However, this case is unique because IgG4-RD developed not only in the liver parenchyma but also in the bile ducts, presenting as stenosis and stricture, which can be diagnosed as IgG4-SC.…”

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A Case of Hepatic Immunoglobulin G4-Related Disease Presenting as an Inflammatory Pseudotumor and Sclerosing Cholangitis

et al. 2022

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An inflammatory pseudotumor is a benign disease characterized by tumor-like lesions consisting of inflammatory cells including plasma cells and fibrous tissue. Recently, some inflammatory pseudotumor cases proved to be a form of Immunoglobulin G4-related disease (IgG4-RD). This novel clinical entity, recognized as a fibroinflammatory condition, is characterized by lymphoplasmacytic infiltration with a predominance of IgG4-positive plasma cells, storiform fibrosis, and often elevated serum IgG4 concentrations. We report a case of IgG4-RD in the form of an inflammatory pseudotumor in the liver with combined sclerosing cholangitis. We recommend that for diagnosing IgG4-RD accurately, it is important to obtain adequate tissue samples and follow-up the lesion in clinical practice.

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Clinical and Multimodal Imaging Features of Hepatic Inflammatory Pseudotumors

Chen,

Luo,

et al. 2024

J of Ultrasound Medicine

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ObjectivesCurrent literature on imaging characteristics of hepatic inflammatory pseudotumor (HIPT) is limited. This study aimed to analyze the contrast‐enhanced ultrasound (CEUS) features in HIPT and compare them with contrast‐enhanced computed tomography (CECT) and contrast‐enhanced magnetic resonance imaging (CEMRI).MethodsA total of 83 patients with histologically proven HIPT from two medical institutions were included in this study. All patients underwent CEUS within 1 week before surgery or biopsy. Some patients received additional CECT or CEMRI. B‐mode ultrasound (BMUS) features, enhancement parameters of CEUS, CECT and CEMRI were analyzed. Chi‐square test was used to compare the enhancement patterns and diagnostic sensitivity between CEUS and CECT/CEMRI.ResultsOn the BMUS, HIPT mainly appeared hypoechoic (83.5%, 66/79), irregular shapes (62.0%, 49/79), heterogeneous echogenicity (72.2%, 57/79), and unclear boundary (65.8%, 52/79). A total of 61.5% (51/83) lesions exhibited mild hyper‐ or iso‐enhancement in the arterial phase (AP), 59.0% (49/83) lesions had internal nonenhanced areas, and most lesions (71.1%, 59/83) showed early wash‐out (<60 seconds) on the CEUS. There were significant differences between CEUS and CECT/CEMRI in enhancement intensity of AP and wash‐out pattern (P < .05). The sensitivity in the diagnosis of HIPT among the three had no statistical difference (P>.05).ConclusionsThe CEUS features of HIPT lesions typically include mildly hyper‐enhanced or iso‐enhanced in AP, rapid wash‐out in PVP, and often small nonenhanced areas within the mass. Furthermore, the wash‐out pattern of CEUS and CECT/CEMRI are inconsistent, more akin to cholangiocarcinoma. The diagnostic efficacy of the three modalities is similar.

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Intrahepatic bile duct rupture associated with IgG4-related sclerosing cholangitis presenting hepatic inflammatory pseudotumor

Cited by 7 publications

References 13 publications

Spontaneous perforation in the bile duct system

Spontaneous perforation in the bile duct system

A Case of Hepatic Immunoglobulin G4-Related Disease Presenting as an Inflammatory Pseudotumor and Sclerosing Cholangitis

Clinical and Multimodal Imaging Features of Hepatic Inflammatory Pseudotumors

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