Biliary Obstruction Caused by an Abdominal Aortic Aneurysm

Excerpt

A 75-year-old man was admitted to our hospital because of increasing painless jaundice. There was no history of liver cirrhosis, chronic hepatitis virus infection, cholelithiasis, or alcohol abuse, and the patient did not receive any operation. Physical examination on admission was unremarkable except for a painless pulsatile abdominal mass. Laboratory test revealed abnormal liver function: total serum bilirubin 163.9 μmol/L(normal range, 5.0–21.0 μmol/L), direct serum bilirubin 116.3 μmol/L, g-glutamyltransferase 811 U/L (normal range, 10–60), alkaline phosphatase 561 U/L (normal range, 45–125), alanine transaminase 361 U/L (normal range, 9–50), aspartate aminotransferase 312 U/L (normal range, 15–40), and prealbumin 11.1 mg/dL (normal range, 17–40). Tumor markers of carbohydrate antigen19-9 (146 U/mL; normal range, 0–39) and ferritin (1278 ng/mL; normal range, 13–400) were elevated, while others including alpha-feto protein and carcinoembryonic antigen were all within normal ranges. A subsequent contrast-enhanced computed tomography (CT) revealed marked dilation of the common bile duct (Fig. 1a, arrow) and the intrahepatic duct (Fig. 1b). CT scan also demonstrated the presence of an abdominal aortic aneurysm (AAA) measuring 7 cm in diameter with circumferential calcification (Fig. 1c, white arrow) and mural thrombus (Fig. 1c, yellow arrow), which was confirmed by virtual CT angiography (Fig. 1d). Digital subtraction angiography (DSA) (Fig. 2a) and endovascular exclusion (EVE) of AAA (Fig. 2b) were performed successfully; however, jaundice continued to aggravate.

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