Idiopathic retroperitoneal fibrosis, also known under the name of Ormond’s disease usually compresses the retroperitoneal structures, especially the ureters. In rare cases other structures such as the biliary system can be involved. We report the case of a 49-year-old patient diagnosed with Ormond’s disease two years before, who developed jaundice and acute cholecystitis due to the progression of the retroperitoneal fibrosis.
Keywords: idiopathic retroperitoneal fibrosis, common bile duct obstruction, acute cholecystitis.
Described for the first time by John Kelso Ormond in 1948, idiopathic retroperitoneal fibrosis usually involves Gerota’s fascia and compresses the For example, retroperitoneal fibrosis might affect the common biliary duct, inducing the appearance of jaundice or unexplained elevated serum hepatic enzymes in association with significant biliary duct enlargement. In the meantime, the presence of jaundice and cholestasis in the absence of upper abdominal pain is usually significantly suggestive for malignancy. Most often performing preoperative studies such as magnetic resonance imaging or endoscopic retrograde cholangiopancreatography usually provides a good orientation of the diagnosis. However, in certain cases this fact is not possible, imposing the necessity of surgery2-4. Extensive primary retroperitoneal fibrosis, also known as Ormond’s disease is most often characterized by the involvement of perirenal tissues although mesenteric and biliary system involvement has been reported so far in extremely rare situations5,6. Its pathogenesis is not fully understood, various hypothesis such as immunologic mechanisms being suspected so far.