White Bile Detected During Endoscopic Retrograde Cholangiopancreatography: A Rare Phenomenon and Its Clinical Implications
Turkish Journal of Gastroenterology, cilt.36, sa.6, ss.408-409, 2025 (SCI-Expanded, Scopus, TRDizin)
- Yayın Türü: Makale / Editöre Mektup
- Cilt numarası: 36 Sayı: 6
- Basım Tarihi: 2025
- Doi Numarası: 10.5152/tjg.2025.25018
- Dergi Adı: Turkish Journal of Gastroenterology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CAB Abstracts, MEDLINE, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.408-409
- Trakya Üniversitesi Adresli: Evet
Özet
Dear Editor, An 87-year-old female patient presented with 1 month of jaundice and intermittent abdominal pain. She had experienced a weight loss of approximately 15 kg over 6 months. Her medical history included hypertension, dia- betes mellitus, and atrial fibrillation. On physical examina- tion, jaundice was noted along with a palpable, painless hydropic gallbladder (Courvoisier–Terrier sign) and exco- riation marks on the skin due to itching. Laboratory tests revealed total bilirubin of 16.5 mg/dL, direct bilirubin of 13.9 mg/dL, alkaline phosphatase of 330 U/L, gamma- glutamyl transferase of 930 U/L, alanine aminotransfer- ase of 125 U/L, aspartate aminotransferase of 107 U/L, C-reactive protein of 17.8 mg/L, and a white blood cell count of 5.6 % 103/�L. Cross-sectional imaging demon- strated a mass lesion causing dilation of the intrahepatic bile ducts, the common bile duct, and the pancreatic duct (double duct sign) (Figure 1A). Radiologically, the patient was diagnosed with an unresectable pancreatic mass. Endoscopic retrograde cholangiopancreatogra- phy (ERCP) was performed for drainage, and endoscopic ultrasonography was performed for diagnostic purposes. During ERCP, following cannulation and stent placement, a large volume of colorless bile was observed (Figure 1B). Within several days, her bilirubin levels and cholestatic enzymes normalized. Histopathological examination revealed pancreatic adenocarcinoma. Since the patient did not meet the criteria for surgical operability, she was referred to medical oncology for systemic chemotherapy