Pyogenic granuloma of the common bile duct in a patient with choledochoduodenostomy

Lee, Chang Kyun; Dong, Song; Jung, Sung Hee; Jang, Ji-Hyun; Kim, H. J.; Kim, B. H.; Chang, Yongjin; Chang, Rin; Kim, Y. W.

doi:10.1055/s-2007-966706

Cited by 8 publications

(6 citation statements)

References 1 publication

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“…Clinically, patients with PG can be asymptomatic or present with overt bleeding from the lesion (7,9). PG has also caused common bile duct obstruction in a single case (10), and dysphagia in two others (5,11). The present case is the first report of a patient with PG presenting with hemodynamically significant GI bleeding requiring massive transfusion of blood products.…”

Section: Cell Population (Immunoperoxidase Stain Original Magnificatmentioning

confidence: 99%

Pyogenic Granuloma: An Unusual Cause of Massive Gastrointestinal Bleeding from the Small Bowel

Moffatt

Warwryko

Singh

2009

Canadian Journal of Gastroenterology

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G astrointestinal (GI) bleeding in the small intestine -distal to the duodenum -is an uncommon entity and is responsible for 4% of all cases of GI bleeding (1). The most common etiologies for small intestinal bleeding are angiodysplasias and tumours, responsible for approximately 70% and 10% of cases, respectively (1,2). Pyogenic granuloma (PG) is a common inflammatory vascular tumour of the skin and oral cavity that has rarely been described in the GI tract as a source of obscure and overt bleeding. In the present report, we describe the first case of massive GI bleeding caused by a small bowel PG, and we review the relevant literature to date regarding the clinical presentation, diagnosis and management of this rare GI lesion. Case presentationThe case of a 78-year-old Caucasian man with longstanding anemia (hemoglobin 80 g/L to 100 g/L) followed by a hematologist for suspected myelodysplasia is reported. On worsening of his anemia, and with decreasing serum ferritin and iron saturation levels, he was diagnosed with iron deficiency anemia and a GI source of blood loss was suspected. Diagnostic esophagogastroduodenoscopy, colonoscopy and small bowel follow-through did not reveal the source of bleeding. A technetium 99m-tagged red blood cell scan was performed and suggested bleeding in the right upper quadrant; however, the source was not clearly identified as being in the large or small bowel.Shortly thereafter, the patient presented to hospital with presyncope, hemodynamic instability and large volume melena. He was hospitalized and required transfusion of eight units of packed red blood cells over a 24 h period. His nadir hemoglobin was 62 g/L, at which point he was transferred to the Health Sciences Centre at the University of Manitoba, Winnipeg, Manitoba, for further assessment and management. An urgent small bowel push enteroscopy identified a 2 cm polypoid lesion approximately 20 cm into the jejunum. The lesion was reddish-blue in colour, with a white coating and superficial ulceration (Figure 1 Small bowel hemorrhage is responsible for approximately 4% of all cases of gastrointestinal bleeding. The etiology of bleeding from the small bowel is a tumour in approximately 10% of cases. Pyogenic granuloma is a common inflammatory vascular tumour of the dermis, which rarely occurs in the gastrointestinal tract. Pyogenic granuloma is a rare cause of overt or obscure small bowel bleeding. The present paper reports the first case of pyogenic granuloma presenting as a massive gastrointestinal bleed, and reviews the relevant literature to date regarding the clinical presentation, diagnosis and management of this rare gastrointestinal lesion.

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Section: Cell Population (Immunoperoxidase Stain Original Magnificatmentioning

confidence: 99%

Pyogenic Granuloma: An Unusual Cause of Massive Gastrointestinal Bleeding from the Small Bowel

Moffatt

Warwryko

Singh

2009

Canadian Journal of Gastroenterology

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“…3 A previous report described a small 5-mm pyogenic granuloma in the distal CBD in a patient with side-to-side choledochoduodenostomy that was resected endoscopically via a large stoma. 4 To our knowledge, resection of a pyogenic granuloma in the CBD at ERCP has not been previously reported. Because our patient had a full recovery and experienced no additional episodes of fevers or bacteremia after the lesion was removed, it can be deduced that this lesion was the precipitating factor for cholangitis.…”

Section: Discussionmentioning

confidence: 84%

Endoscopic resection of distal bile duct mass (with video)

Trevino¹,

Wilcox

Jhala

et al. 2009

Gastrointestinal Endoscopy

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“…Endoscopic snare polypectomy for benign polypoid bile duct masses such as pyogenic granulomas or neurofibromas, although rare, has been described in the literature . Two reports described choledochal polyp resection using a snare under standard enfacement with a conventional side‐viewing duodenoscope using a retrieval balloon to move the mass to the outer side of the sphincterotomy site.…”

Section: Discussionmentioning

confidence: 99%

“…Two reports described choledochal polyp resection using a snare under standard enfacement with a conventional side‐viewing duodenoscope using a retrieval balloon to move the mass to the outer side of the sphincterotomy site. Another report has described common bile duct polyp removal using snare polypectomy through a wide stoma of side‐to‐side choledochoduodenostomy using a forward‐viewing endoscope. To our knowledge, the use of EMR under direct POC after submucosal injection for the management of a cholangiocarcinoma in the IHD has not been reported.…”

Section: Discussionmentioning

confidence: 99%

“…polypoid bile duct masses such as pyogenic granulomas or neurofibromas, although rare, has been described in the literature. [3][4][5][6] Two reports 4,5 described choledochal polyp resection using a snare under standard enfacement with a conventional side-viewing duodenoscope using a retrieval balloon to move the mass to the outer side of the sphincterotomy site. Another report 3 has described common bile duct polyp removal using snare polypectomy through a wide stoma of side-to-side choledochoduodenostomy using a forward-viewing endoscope.…”

Section: E Ndoscopic Snare Polypectomy For Benignmentioning

confidence: 99%

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Endoscopic mucosal resection for intraductal growing‐type intrahepatic cholangiocarcinoma under direct peroral cholangioscopy

Jung

Park

Shin

2018

Digestive Endoscopy

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The current standard treatment for intrahepatic cholangiocarcinoma is surgical resection. However, in case the patient does not agree with surgical resection or is not fit for surgery, there are a few alternative treatments. We present a case of an 83-year-old male patient with abdominal pain who was diagnosed with polypoid intrahepatic cholangiocarcinoma in the left intrahepatic duct (IHD) with peripheral IHD dilatation. He refused to undergo curative surgery. Alternatively, he underwent endoscopic mucosal resection (EMR) with direct peroral cholangioscopy (POC) using standard upper endoscopy with a transparent cap. At 1-year follow up, there was no evidence of locoregional recurrence or distant metastasis. We suggest that intraductal EMR could serve as an effective and safe alternative treatment for patients with polypoid intrahepatic cholangiocarcinoma using direct POC.

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Pyogenic granuloma of the common bile duct in a patient with choledochoduodenostomy

Cited by 8 publications

References 1 publication

Pyogenic Granuloma: An Unusual Cause of Massive Gastrointestinal Bleeding from the Small Bowel

Pyogenic Granuloma: An Unusual Cause of Massive Gastrointestinal Bleeding from the Small Bowel

Endoscopic resection of distal bile duct mass (with video)

Endoscopic mucosal resection for intraductal growing‐type intrahepatic cholangiocarcinoma under direct peroral cholangioscopy

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