A case report of intraductal papillary tumor with biliopancreatic fistula causing mucinous biliary obstruction and cholangitis

Abstract

A 87-year-old woman was admitted to our hospital with fever and jaundice. Ultrasonography showed the hyperechoic mass in the dilated common bile duct. Computed tomography and MR cholangiography demonstrated dilatation of the bile duct, cystic lesions in the tail of the pancreas, and the communication between common bile duct and dilated branch of pancreatic duct in the head of the pancreas. Endoscopy showed dilatation of the orifice of the major papilla and the minor papilla caused by mucus flow. Endoscopic retrograde cholangiopancreaticography revealed mucus in the dilated common bile duct and the fistula between common bile duct and the dilated branch of pancreatic duct. These findings were characteristic of intraductal papillary tumor with biliopancreatic fistula. Endoscopic sphincterotomy was performed and a plastic stent was placed in the common bile duct. A few days later, fever and jaundice disappeared. Endoscopic therapy was useful for patients with bile duct obstruction and jaundice due to masses of mucus.