Endoscopy 2007; 39: E282-E283
DOI: 10.1055/s-2007-966706
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Pyogenic granuloma of the common bile duct in a patient with choledochoduodenostomy

C.  K.  Lee1 , S.  H.  Dong1 , S.  H.  Jung1 , J.  Y.  Jang1 , H.  J.  Kim1 , B.  H.  Kim1 , Y.  W.  Chang1 , R.  Chang1 , Y.  W.  Kim2
  • 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kyung Hee University, School of Medicine, Seoul, Korea
  • 2Department of Pathology, Kyung Hee University, School of Medicine, Seoul, Korea
Further Information

Publication History

Publication Date:
24 October 2007 (online)

Pyogenic granuloma is a polypoid form of capillary hemangioma that occurs mostly on the skin and the mucous membranes of the nasal and oral cavities [1]. Although pyogenic granuloma in the digestive tract excluding the oral cavity is a rarity, it can cause significant gastrointestinal bleeding, and curative resection is required for treatment in most cases [2]. We describe a case of pyogenic granuloma of the common bile duct (CBD) that was observed on endoscopy and was successfully treated by endoscopic snare polypectomy.

A 69-year-old woman was admitted to our hospital with a 1-day history of right upper quadrant pain. She had a history of cholecystectomy and CBD exploration with side-to-side choledochoduodenostomy and recurrent attacks of cholangitis. On endoscopic retrograde cholangiography (ERC) using an Olympus duodenoscope (JF-240; Olympus Optical Co., Tokyo, Japan), the CBD was cannulated with a balloon catheter through the wide stoma of the side-to-side choledochoduodenostomy ([Fig. 1] a) and the CBD visualized. A nonmovable, small, round filling defect was noted in the dilated distal CBD ([Fig. 1] b). Because of the wide stoma of the choledochoduodenostomy and the dilated CBD, it was possible to insert a forward-viewing endoscope (Olympus GIF-Q260; Olympus Optical Co.) through the stoma into the distal CBD. This showed a semipedunculated, smooth polypoid lesion that was 5 mm in diameter, hyperemic, and dark red in the distal CBD, with a tinge of blood on its surface ([Fig. 2] a). The lesion was removed by snare polypectomy without any complications ([Fig. 2] b). On the basis of histopathological analysis of the resected tissue ([Fig. 3]), the lesion was diagnosed as a pyogenic granuloma. To the best of our knowledge, this is the first reported case of pyogenic granuloma in the bile duct.

Fig. 1 a Duodenoscopic findings of a wide stoma in the side-to-side choledochoduodenostomy in the duodenum (arrow). b Endoscopic retrograde cholangiogram showing dilated distal common bile duct with a nonmovable, small, round filling defect (arrow).

Fig. 2 a Endoscopic view of the polypoid lesion in the distal common bile duct. b No residual lesion in the distal common bile duct after endoscopic snare polypectomy.

Fig. 3 a Histological section of the resected specimen showing proliferation of small capillary-sized blood vessels and surface ulceration, accompanied by lymphocytic infiltration in the intervening stroma (hematoxylin and eosin, original magnification, × 200). b Immunohistochemical staining for CD31 shows strong positivity in endothelial cells lining the small blood vessels (original magnification, × 400).

Endoscopy_UCTN_Code_CCL_1AZ_2AC

Endoscopy_UCTN_Code_CCL_1AZ_2AN

References

S. H. Dong, MD, PhD

Division of Gastroenterology and HepatologyDepartment of Internal Medicine
Kyung Hee University Hospital

Hoegi-Dong 1
Dongdaemun-Gu
Seoul
130-702
Korea

Fax: +82-2-9681848

Email: gidrdong@chol.com