Immunoglobulin G4-associated cholangitis mimicking cholangiocarcinoma treated by laparoscopic choledochectomy with intracorporeal Roux-en-Y hepaticojejunostomy

World J Surg Oncol. 2014 Nov 29:12:363. doi: 10.1186/1477-7819-12-363.

Abstract

Immunoglobulin G4 (IgG4)-associated disease is a recently recognized disease entity that is characterized by elevated serum IgG4 concentrations, abundant IgG4 lymphoplasmacytic infiltration, and dramatic steroid responses. IgG4-associated cholangitis is one manifestation of IgG4-associated disease. However, it is clinically challenging to make a preoperative differentiation between this rare disease and cholangiocarcinoma, especially for those with serum concentrations of IgG4 in the normal range. This article reports on a 57-year-old man with jaundice and upper abdominal discomfort. Imaging examination showed biliary stricture that closely resembled cholangiocarcinoma, and the patient's serum IgG4 concentration was normal. The patient underwent a laparoscopic choledochectomy with Roux-en-Y hepaticojejunostomy using an intracorporeal hand-sewn technique. He recovered quickly without any complications. We also present our experience in laparoscopic intracorporeal hand-sewn hepaticojejunostomy.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anastomosis, Roux-en-Y*
  • Bile Duct Neoplasms / diagnosis
  • Bile Duct Neoplasms / immunology
  • Bile Duct Neoplasms / surgery*
  • Bile Ducts, Intrahepatic / immunology
  • Bile Ducts, Intrahepatic / pathology
  • Bile Ducts, Intrahepatic / surgery*
  • Cholangiocarcinoma / diagnosis
  • Cholangiocarcinoma / immunology
  • Cholangiocarcinoma / surgery*
  • Cholangitis / diagnosis
  • Cholangitis / immunology
  • Cholangitis / surgery*
  • Diagnosis, Differential
  • Humans
  • Immunoglobulin G / immunology*
  • Jejunostomy*
  • Laparoscopy*
  • Liver Neoplasms / surgery*
  • Male
  • Prognosis

Substances

  • Immunoglobulin G