Use of cholangioscopy in post cholecystectomy cystic duct neuroma presenting as bile duct tumour, not all that glitters is malignant. These are our keywords, 60 year old female presented with symptoms of abdominal pain in the epigastric region for a duration of 1 month. She had a past history of cholecystectomy 24 years back as well as history of cervical carcinoma for which she was operated 16 years ago. Imaging showed a dilated CBD with IHBR and smooth distal narrowing with an enhancing polypoidal lesion projecting into the proximal CBD lumen, possible mitosis. This is the contrast imaging of the abdomen showing the lesion in the common bile duct. These are our lab parameters which were within normal limits. She was planned for an endoscopic ultrasound and subsequent endoscopic retrograde cholangiopancreatography. Linear EUS endoscope at the duodenal bulb showed an hyperechoic mass arising from the cystic duct. It was seen protruding into the common bile duct, CBD appeared dilated with IHBRD, patient was taken up for ERCP, SPI DS2 cholangioscope was introduced over an hydrophilic wire, indentation over the bile duct could be seen, the cystic duct tumour was visualized using the SPI bite forceps, biopsy was taken and sent for histopathology, biliary stenting was done. Histopathology revealed spindle cell proliferation consistent with cystic duct neuroma, immunochemical staining with S100 was positive. The patient underwent biliary stenting with her post procedure period uneventful, presently she is asymptomatic and on regular follow up. Cystic duct neuroma is a non neoplastic proliferation at the site of nerve injury. It is a rare complication caused by tumour secondary to cholecystectomy, pathologically they are characterized by spindle cell proliferation and are positive for S100 immunochemical staining. Neurological removal is only indicated if patients are symptomatic, conclusion traumatic neuroma should be considered in the differential diagnosis in patients presenting with suspected bile duct tumour and having prior history of cholecystectomy with normal CA19-9 levels. This case demonstrates the use of SPI glass cholangioscopy in diagnosing cystic duct neuroma thereby avoiding surgical exploration.

abdominal pain

bile duct tumor

cystic duct neuroma

endoscopic ultrasound

SPI glass cholangioscopy