Case report: A typical biliary obstruction secondary to metastatic endometrial cancer

Endometrial cancer (EC) is a prevalent gynecological malignancy that may present with metastatic spread to pelvic and periaortic lymph nodes. 5 This case report details a 67-year-old female with a history of metastatic EC who presented with biliary colic. Ultrasound revealed dilated biliary ducts without intrahepatic obstruction, identifying an extrinsic periaortic mass compressing the distal common bile duct (CBD). The mass represented a conglomerate of metastatic lymph nodes tethering the duodenum, with associated duodenal wall thickening attributed to prior radiation therapy. The patient underwent three unsuccessful endoscopic retrograde cholangiopancreatography procedures for CBD stenting and later presented with severe abdominal pain, jaundice, and elevated pancreatic and liver enzymes. This case highlights a rare presentation of biliary obstruction secondary to extrinsic compression from metastatic EC, emphasizing the importance of considering the patient's oncologic history and thoroughly evaluating the distal CBD during ultrasound examinations. The case underscores potential challenges of managing biliary obstruction in patients with complex, metastatic malignancies and the need for a comprehensive diagnostic approach.