Challenges in diagnosing and treating distal common bile duct adenocarcinoma: A case report with literature insights

Challenges in diagnosing and treating distal common bile duct adenocarcinoma: A case report with literature insights

Roux-en-Y hepaticojejunostomy, Right upper abdominal pain, Common bile duct adenocarcinoma,
Intrahepatic bile ducts, Obstructive jaundice, Lymphovascular invasion

Abstract
Background Adenocarcinoma of the distal common bile duct (CBD) is a rare and aggressive malignancy that is often
diagnosed at an advanced stage owing to nonspecific symptoms and delayed presentation. This case report details
the diagnostic and therapeutic challenges associated with distal CBD adenocarcinoma and highlights the need for an
effective multidisciplinary approach.
Case presentation A 54-year-old male with a significant smoking history presented with persistent right upper
abdominal pain, dark urine, and scleral jaundice. Imaging studies revealed intrahepatic bile duct dilatation, a mass
obstructing the common bile duct, and thickened gallbladder walls. Despite initial antibiotic therapy for suspected
cholangitis, the patient underwent endoscopic retrograde cholangiopancreatography (ERCP) and subsequently a
surgical procedure. The surgical resection of a common bile duct adenocarcinoma with lymphovascular invasion
was successful, with subsequent restoration of bile flow through Roux-en-Y hepaticojejunostomy. Histopathological
analysis confirmed tumor characteristics and clear surgical margins. Postoperatively, the patient demonstrated
significant clinical improvement with normalized bilirubin levels and received appropriate management for his
oncologic condition.
Conclusion This case highlights the diagnostic complexity of distal CBD adenocarcinoma, particularly in patients
with delayed symptoms. Multimodal imaging approaches and timely surgical intervention are crucial for effective
management of this malignancy. Enhanced awareness of atypical presentations and advancements in targeted
therapies holds promise for improving outcomes in such challenging cases.
Keywords Roux-en-Y hepaticojejunostomy, Right upper abdominal pain, Common bile duct adenocarcinoma,
Intrahepatic bile ducts, Obstructive jaundice, Lymphovascular invasion

Sakhr Alshwayyat1,2,3, Hamdah Hanifa4* , Yamen Alshwaiyat5

, Mustafa Alshwayyat6

, Hussein Alhussein7
,

Malak Abu-Naja8 , Tala Abdulsalam Alshwayyat2

, Basil Alsaleh9 , Mohammad Shafa’a10 and

Muhammad Fadi Alkurdi10

https://doi.org/10.1186/s12245-025-00859-7

2025

Peri Irawan

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