Obstructive jaundice secondary to metastatic gastric adenocarcinoma

Abstract

Cancer related obstructive jaundice is commonly associated with pancreatic biliary malignancies but is an uncommon manifestation of gastric carcinoma. The occurrence of malignant biliary obstruction in patients with previously treated gastric cancer is rare and generally indicates advanced metastatic disease with poor prognosis. A 39-year-old male with a history of gastric adenocarcinoma diagnosed in 2024, treated with total gastrectomy (pT4N3aM) and chemotherapy (FLOT regimen 8 cycles followed by FOLFIRI & Nivolumab 9 cycles), presented with progressive jaundice, dark coloured urine and abdominal distension. Laboratory investigations revealed elevated total bilirubin, alkaline phosphatase and gamma-glutamyl transferase. Contrast enhanced imaging demonstrated intrahepatic biliary radicle dilation, proximal common bile duct dilation, abrupt mid common bile duct narrowing suggestive of malignant stricture, pancreatic duct dilation, moderate ascites and bilateral hydronephrosis. Ascitic fluid analysis excluded spontaneous bacterial peritonitis. Right sided double-J ureteric stenting was performed for hydrouteronephrosis. Due to altered postoperative anatomy (gastrectomy), percutaneous transhepatic biliary drainage was undertaken. Cholangiography confirmed proximal common bile duct stricture and a self-expanding metallic stent (SEMS) was deployed percutaneously. Significant biliary decompression and symptomatic improvement was achieved. Malignant biliary obstruction due to metastatic gastric cancer is an uncommon clinical entity and associated with significant complications. In patients with altered anatomy after gastrectomy, percutaneous transhepatic biliary drainage with metallic stent placement provides effective palliation and symptomatic relief.