Biliary hypertension syndrome in the practice of a gastroenterologist. A case report

Abstract

Introduction. Major duodenal papilla (MDP) adenomas are rare, up to 0.2-1.0% of all tumors of the gastrointestinal tract. Their diagnosis is often difficult, which is clearly reflected in the presented case.
Brief description. A 46-year-old patient fell ill acutely in September 2024 with a picture of acute respiratory disease. After two courses of antibacterial therapy, jaundice, skin itching, cytolysis and cholestasis syndromes appeared. The patient was observed with a diagnosis of drug-induced hepatitis with a moderate positive effect from hepatotropic therapy. In December 2024, symptoms relapsed, and the patient was hospitalized in one of the city hospitals, where viral, autoimmune liver diseases, liver vascular thrombosis, and cardiovascular pathology were ruled out. According to the abdominal ultrasound, pancreatic hypertension was detected. When Contrast-enhanced abdominal computed tomography revealed biliary hypertension with suspected choledocholithiasis, stenosis of the common bile duct terminal part, which were subsequently not confirmed by magnetic resonance imaging. Major duodenal papilla adenoma was suspected and confirmed by histological examination during repeated gastroscopy, 5 months after the disease onset.
Discussion. The presented case demonstrates the pathological process at all stages, the results of numerous diagnostic studies used to verify the diagnosis, a list of nosological units and a discussion of their probability in the context of differential diagnostics.