Amputation Neuroma of Common Bile Duct With Obstructive Jaundice

Amputation neuroma of extrahepatic bile duct as a rare cause of postcholecystectomy pain

“…The dissection of sympathetic nerve fibers does not always result in the formation of an amputation neuroma. Exact mechanisms and prerequisites leading to the formation of amputation neuromas are not known [5].…”

“…Since amputation neuromas usually have no characteristic features enabling them to be detected, the preoperative diagnosis is difficult despite modern imaging techniques [5,6,9]. ERCP is invaluable when the patient is presented with obstructive jaundice.…”

“…Domagk et al compared the impact of ERCP, MRCP and IDUS in a prospective study and found that IDUS gives more reliable and precise information in differential diagnosis of biliary duct strictures [14]. Surgery, however, may be necessary for diagnosis, especially in patients with postcholecystectomy pain who have no evidence of biliary obstruction [5,6,9]. The final diagnosis can only be made histologically.…”

“…Operative injury to pericholangial nerve fibers induces reactive proliferation of nerve tissues and results in tumorous hyperplasia. Most amputation neuromas of the biliary tract occur in the cystic duct stump or in the wall of the bile duct after cholecystectomy, either laparoscopic or open, and choledochotomy [4,5]. Although this disease is referred to a neuroma, it is not a true neoplasm [5,6].…”

“…Most amputation neuromas of the biliary tract occur in the cystic duct stump or in the wall of the bile duct after cholecystectomy, either laparoscopic or open, and choledochotomy [4,5]. Although this disease is referred to a neuroma, it is not a true neoplasm [5,6]. The interval between initial surgery and symptoms may range from 2 months to more than 30 years [4,7,8].…”