A CASE OF OBSTRUCTIVE JAUNDICE CAUSED BY LAMELLAR PARTICLES OF UNKNOWN ORIGIN IN THE COMMON BILE DUCT

A case of obstructive jaundice caused by infiltration of the common bile duct by a large quantity of lamellar particles is described. The patient was a 34-year-old Iranian male who experienced sudden onset of fever, jaundice and right upper quadrant pain. He had had a similar episode six years previously in Iran. On admission, he exhibited marked tendeness and spontaneous pain in the right upper quadrant. Blood analysis demonstrated elevation of serum bilirubin, transaminase, and alkaline phosphatase. Ultrasonography and computed tomography suggested that the obstructive jaundice was caused by the presence of stones in the common bile duct. Cholecystectomy was performed, and choledocholithotomy revealed a large quantity of lamellar particles. Moreover, identical particles were found in the gallbladder. On pathological examination, these particles were found to have a homogeneous, lamellar structure, and numerous bacterial colonies were scattered throughout them. The bacteria appeared to be a species of Actinomyces. The origin of the particles could not be confirmed, but they were thought to have formed from mucus secreted from proliferative glands in response to bacterial infection of the biliary tract.