381 A Rare Case of CBD obstruction secondary to Endometriotric cyst

Background

Bile flow obstruction due to bilary tree pathology is well documented. Intramural causes include gallstones and infections such as clonorchis sinensis and Ascaris Lumbriocodes1 mural causes include autoimmune diseases e.g Sclerosing cholangitis. Extrinsic compression are usually due to malignancy e.g Cholangiocarcinoma or pancreatic head carcinoma. we encountered a rare case of common bile duct (CBD) obstruction cause by large endometriotic cyst.

Case report

A fit & well, 85 year old female presented with gradual onset of Obstructive jaundice. admission Liver function tests indicated a Bilirubin of 485 subsequent Ct scan revealed a large endometriotic Cyst (15cm x10 cm) indenting the CBD and stomach. Endoscopic ultrasound confirmed the presence of a large cystic fluid collection. Patient`s biliary system was indirectly decompressed with AXIOSTM via gastric wall into cyst Copious dark brown non-viscous fluid was drained into stomach. Cytology results reported benign cyst contents without mucin or neoplastic epithelial cells. Fluids Amylase was 121 U/L. the patient recovered well, with resolution of Bilirubin.

Discussion

Endometriotic cyst have been reported to cause organ obstruction such as CBD and ureter1,2 patient's from previously reported cases had to endure major surgery to achieve symptomatic relief.

AXIOSTM stent is a device commonly utilized for drainage of pancreatic pseudocyst and we report the use of it as a Novel and minimally invasive technique in this rare case of CBD obstruction.

References:

1-A clinical pathway on endoscopic retrograde cholangiopancreatography for common bile duct stones. World J Gastroenterol. 2019 Feb 28;25(8):1002-1011.

2-Liver Tumours Due To Endometriosis And Endometrial Stromal Sarcoma".