Obstructed by Metastasis: Dual Biliary and Gastric Outlet Obstruction from Metastatic Breast Carcinoma.
Pushkar Galam, Harish Venketachalam, Dakshayani S Nirhale
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Case in brief
A 57-year-old woman with a history of HER2-positive, hormone-receptor-negative breast carcinoma treated four years earlier presented with jaundice, vomiting, early satiety, and weight loss. Testing showed cholestatic jaundice; imaging identified a porta hepatis mass compressing the distal common bile duct and narrowing the D1–D2 duodenum. Endoscopic ultrasound-guided biopsy showed metastatic adenocarcinoma consistent with breast origin. Because anatomy precluded endoscopic biliary stenting, she underwent palliative cholecystojejunostomy and gastrojejunostomy. Jaundice resolved, oral intake returned, and symptoms improved.
What made this case unusual
Metastatic breast carcinoma caused simultaneous biliary and gastric outlet obstruction, with imaging that could suggest a primary hepato-pancreato-biliary malignancy.
Diagnostic / clinical pearl
In a patient with prior breast carcinoma and new biliary or upper gastrointestinal obstruction, consider metastatic disease and use tissue diagnosis to establish the primary origin.
Why it matters
When endoscopic biliary intervention is anatomically infeasible, this case describes surgical double bypass as a palliative approach associated with symptom relief.