An unusual post-traumatic case of extrahepatic bile duct compression

Jaundice and cholestatic disease by external bile duct compression may be caused by several conditions, including pancreatic masses, portal cavernoma, Ormond's disease, metastases from gallbladder cancer, neurinomas, and hydronephrotic kidney. We report a case of bile duct compression in a 56-year-old man with a known small (28 mm) right renal cyst and crossed, fused renal ectopia. The patient had a history of recent abdominal trauma due to a motorcycle accident and recurrent septic-type fever and jaundice. He also reported a weight loss of 5 kg in the last two months. Abdominal ultrasonography showed intra- and extra-hepatic bile duct dilatation, and computed tomography scan showed hydronephrosis, dilatation of intra- and extra-hepatic biliary tract, and a right renal complex cyst of more than 9 cm. One can hypothesize a relationship between the abdominal trauma and the increase in size of the renal cyst, which, moreover, had changed its original shape. The patient underwent cefuroxime and metronidazole therapy, with complete recovery from the cholangitis within one week. The treatment of choice would have been surgical excision or, alternatively, an image-guided percutaneous aspiration of the cyst, in order to avoid further episodes of cholangitis. Unfortunately, the patient refused either surgical or more conservative treatment and was lost to follow-up.