Diagnosis and treatment for adenomyomatosis of distal bile duct

Abstract

Adenomyomatosis arising in the distal bile duct is extremely rare and mimics frequently neoplasm of bile duct. We review the clinical features of adenomyomatosis of distal bile duct. In total, 60 cases of adenomyomatosis of the distal bile duct and ampullary lesions including our five cases are reported from 1980 to 2008. Thirty-three were men and 27 were women. The mean age was 64 years (range: 31-82 years). Right quadrant pain or epigastralgia was seen more than half of the patients. Jaundice was seen in 49% of the patients. Adenomyomatosis of distal bile duct is usually diagnosed by histopathologic examination after surgery. Abdominal computed tomography shows the lesion to be a low-attenuating mass with a dilatation of the proximal bile duct. Although radiographic findings are not typical of biliary tract carcinoma, the preoperative diagnosis is still very difficult to make. Of 58 patients who underwent surgical treatment, 37 (64%) patients underwent pancreaticoduodenectomy. Thirteen patients underwent transduodenal treatment. In recent years, endoscopic or transhepatic sphicterotomy is reported in some cases. It may be difficult to diagnose as adenomyomatosis by endoscopic biopsy findings. When the lesion had been definitely diagnosed as adenomyomatosis, endoscopic or transhepatic procedures might be best in addition to detailed follow-up plans.