Obstructed by Metastasis: Dual Biliary and Gastric Outlet Obstruction from Metastatic Breast Carcinoma

Abstract

Metastatic involvement of the biliary tract and gastrointestinal (GI) system secondary to breast carcinoma is exceedingly rare. We hereby report a case of a 57-year-old woman with a past history of Human Epidermal Growth Factor Receptor 2-positive, estrogen and progesterone receptor-negative breast carcinoma treated 4 years earlier, who presented with jaundice, vomiting, early satiety, and significant weight loss. Biochemical evaluation revealed a cholestatic pattern of jaundice. Magnetic resonance cholangiopancreatography and contrast-enhanced computed tomography revealed intrahepatic biliary dilatation secondary to a mass at the porta hepatis compressing the distal common bile duct, along with significant narrowing of the D1–D2 segment of duodenum. Endoscopic ultrasound-guided biopsy confirmed metastatic adenocarcinoma consistent with a breast primary. Due to anatomical constraints precluding endoscopic biliary stenting, the patient underwent palliative double bypass surgery of cholecystojejunostomy and gastrojejunostomy. Postoperatively, the patient demonstrated resolution of jaundice and restoration of normal oral intake, with marked symptomatic improvement. This case highlights a rare metastatic presentation of breast carcinoma closely mimicking primary hepato–pancreato–biliary malignancies, posing a significant diagnostic challenge. A high index of suspicion is thus essential in patients with a prior history of breast cancer presenting with biliary or upper GI symptoms. In cases where endoscopic interventions are not feasible, surgical double bypass proves to be an effective palliative strategy for symptom relief.