General Surgery Podium Presentation: A Rare Case of Cocaine Induced Biliary Tree Constriction in a Middle Aged Male

ON-DEMAND

Primary Presenter(s)

Karlbuto Alexandre, DO

Resident Physician
Detroit Medical Center - Sinai Grace
Detroit Medical Center Sinai Grace Hospital

Author(s)

CH

Christopher Husko, DO

Resident Physician
DMC Sinai Grace Hospital
JH

James Hebden, BS

Medical Student
Michigan State University College of Osteopathic Medicine
JB

John Barnwell, MD, FACS

Attending Surgeon
DMC Sinai Grace Hospital

Participants should be aware of the following financial/non-financial relationships:

Karlbuto Alexandre, DO: Disclosure information not submitted.

Christopher Husko, DO: Disclosure information not submitted.

James Hebden, BS: Disclosure information not submitted.

John Barnwell, MD, FACS: Disclosure information not submitted.

Introduction/Purpose: This is a case of a 62 year old male with a history of extensive cocaine use and cholecystectomy that presented to the emergency department with abdominal pain, urobilia, nausea, and vomiting. The patient had elevated total bilirubin (5.2) and direct bilirubin (3.7). CTA subsequently showed a mass in the gallbladder fossa measuring 3.8 x 2.1 cm. MRCP showed a 4.9 x 3.0 cm mass at the porta hilium with dilated proximal biliary ducts and abrupt transition at the porta hilium.

Methods or Case Description: ERCP was performed with brush biopsy which showed predominantly benign ductal epithelium with rare atypical cells. CA 19-9 levels were mildly elevated at the time, only 94.3. Interventional radiology placed an internal-external biliary drain. The patient was discharged and told to obtain endoscopic ultrasound (EUS) as an outpatient, and return for follow-up. The patient was eventually re-admitted and discharged for other issues several times. He never followed up outpatient to receive EUS. On last admission to the hospital CT scan showed no biliary tree obstruction which was further confirmed on removal internal external biliary drain.

Outcomes: The patient never followed for outpatient EUS to further rule out malignancy. We suspect the patient's initial symptoms and radiographic findings of biliary tree constriction may have been induced by cocaine use. Evidence in the literature states that cocaine use can precipitate Sphincter of Oddi dysfunction leading to obstructive jaundice. This is a rare case that has not been described in the literature.

Conclusion: At this present time there is no direct correlation between cocaine use and biliary tree constriction. We highly suspect that this patient's obstructive jaundice and biliary tree constriction was caused by underlying cocaine use.

Learning Objectives:

Learn the effects of cocaine on the natural physiology of the body.
Learn the effect of cocaine on the gastrointestinal tract and how this can affect the general surgeron.
Discuss the different theories we have with regards to why our patients pathology disappeared.