Cholangiocarcinoma - PTBD and 2 SEMS placed.
Status post Cholecystectomy
My father had obstructive jaundice. He had undergone cholecystectomy in recent past. On evaluation he had hilar stricture with cholangitis. ERCP and biliary drainage was attempted but in view of narrowed duodenal lumen, scope could not be negotiated till ampula and hence PTBD was done and after initial external drainage, 2 SEMS were placed in the right and left duct. He had ascites and right pleural effusion which were drained. Brush cytology showed high grade dysplasia. His bile culture grew Pseudomonas which were sensitive to Cilastin and Imipenem which he recieved for 10 days.
Is surgery possible in this case?
USG Abdomen (24.04.09)
Status post cholecystectomy
Small ill defined hypoechoic mass lesion in the porta hepatic involving the CBD. Mild IHBD in both lobes of liver.
Portal vein thrombosed. Minimal scites.
MRI - MRCP (24.04.09)
Common hepatic duct, confluence and proximal hepatic ducts stricturous lesions with upstream dilation - ? Neoplastic
Triphase/Dual Phase CT (25.04.09)
1. Post cholecystectomy status.
2. Poorly enhancing ill defined lesion at hilum with Type IV biliary structure and long segment portal vein thrombosis.
3. Minimal Ascites. No lymphadenopathy.
D/D - ? Chlongiocarcinoma
? Carcinoma Gall Bladder.
Cytology (Ascitic fluid) (29.04.09)
Inflammatory effusion. Negative for malignancy.
Cytology (Balloon) (01.05.09)
Sparsely cellular smear with high grade dysplasia.
Suggested ERCP and radiological correlation.