Case Report
 
First case of a primary biliary phytobezoar
Fahad Albogami1,3, Alan N. Barkun1,2, Kevin Waschke1
1Division of Gastroenterology, The McGill University Health Centre, Montreal General Hospital site, Montréal, Canada
2Epidemiology and Biostatistics and Occupational Health, McGill University Health Center, McGill University, Montreal, Canada
3Division of Gastroenterology, King Fahad Specialist Hospital, Dammam, Saudi Arabia

Article ID: Z01201801CR10875FA
doi: 10.5348/ijcri-201806-CR-10875

Corresponding Author:
Dr. Alan N. Barkun,
Division of Gastroenterology, The McGill University Health Centre,
Montreal General Hospital site,
1650 Cedar Avenue, Room D7-346,
Montrèal, Canada H3G 1A4

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How to cite this article
Albogami F, Barkun AN, Waschke K. First case of a primary biliary phytobezoar. Int J Case Rep Images 2018;9(1):43–46.


ABSTRACT

Introduction: We present a patient with an unusual cause of biliary obstruction.
Case Report: A 50-year-old male was presented with a five-month history of worsening recurrent biliary abdominal pain and fevers. There was no previous biliary surgery. His workup revealed a normal bilirubin with elevation of other liver tests. Abdominal ultrasound demonstrated a common bile duct (CBD) diameter of 6 mm and cholelithiasis. A magnetic resonance cholangiopancreatography was unremarkable. An endoscopic ultrasound showed gallbladder sludge and stones, as well as CBD wall thickening with sludge in its mid to distal segments. At endoscopic retrograde cholangiopancreatography, a CBD filling defect was noted. After sphincterotomy, a balloon catheter extracted what looked like a cast occupying the entire lower CBD, extending into the cystic duct. This was retrieved in one piece using a rat tooth forceps and sent for pathology. The patient was discharged without complication. Cholecystectomy was recommended. Pathological analysis revealed the concretion was made of vegetable material. There have only been eight cases of biliary phytobezoar described in the modern English medical literature. Most reports describe the occurrence of a biliary phytobezoar presenting up to 40 years following a surgical bilioenteric anastomosis either with associated choledocholithiasis or alone. There exist only two case reports of patients having developed a biliary phytobezoar in the absence of any bilioenteric anastomosis or fistula. In both, the bezoar acted as a nidus for CBD stone formation, although the mechanism for developing a phytobezoar is not completely understood.
Conclusion: We describe the first reported case of an isolated biliary phytobezoar in the absence of previous biliary surgery or bilioenteric fistula.

Keywords: Endoscopic retrograde cholangiopancreatography (ERCP), Phytobezoar, Post-biliary surgery


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Author Contributions
Fahad Albogami – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Alan N. Barkun – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Kevin Waschke – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
None
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© 2018 Fahad Albogami et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.