P1424 - Malignant Gallbladder Adenocarcinoma in a Patient With Prader-Willi Syndrome: A Complex Case of Obstructive Jaundice and Gastric Outlet Obstruction Requiring Palliative Gastrojejunostomy
Wright Center for Graduate Medical Education Scranton, PA
Sunny Kumar, MD1, Rahul Kumar, MD2, Ashok Kumar, MD3, Avinash Nankani, MBBS4, Archit Garg, MD5, Vikash Kumar, MD6, Hany Eskarous, MD7, Aman Ali, MD8 1Wright Center for Graduate Medical Education, Scranton, PA; 2North Central Bronx Hospital, Bronx, NY; 3Ascension Saint Joseph Hospital, Chicago, IL; 4Dow University of Health Sciences, Karachi, Sindh, Pakistan; 5Saint Peter's University Hospital / Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ; 6Creighton University School of Medicine, Phoenix, AZ; 7The Wright Center for Graduate Medical Education, Scranton, PA; 8Wilkes-Barre General Hospital, Scranton, PA Introduction: Gallbladder adenocarcinoma is an uncommon but highly aggressive malignancy, representing approximately 1.2% of all cancers globally. It is often diagnosed at an advanced stage due to vague, nonspecific symptoms. To date, gallbladder cancer has rarely been reported in patients with Prader-Willi Syndrome. We present a unique case of advanced gallbladder adenocarcinoma in a middle-aged man with Prader-Willi syndrome, complicated by malignant biliary and gastric outlet obstruction requiring endoscopic palliation.
Case Description/
Methods: A 46-year-old male with Prader-Willi syndrome, diabetes, hypothyroidism, and seizure disorder presented with persistent vomiting and poor oral intake. Due to cognitive impairment, history was obtained from his parents. Imaging showed a gallbladder mass with porta hepatis involvement and extensive lymphadenopathy. Endoscopic Ultrasound (EUS) and Endoscopic Retrograde Cholangiopancreatography (ERCP) confirmed a malignant-appearing 8.5 cm gallbladder mass with bulky para-aortic and gastrohepatic lymph nodes. Fine needle aspiration (FNA) confirmed gallbladder adenocarcinoma. A 10 mm × 8 cm covered biliary metal stent was placed. Weeks later, he returned with worsening vomiting and jaundice. Labs revealed elevated bilirubin (25.2 mg/dL), ALP (2067), and hyponatremia (Na 128). Imaging showed biliary stent occlusion, hepatic metastases, and gastric outlet obstruction from extrinsic lymphadenopathy. Repeat ERCP revealed complete biliary stent occlusion. A duodenal stent and EUS-guided gastrojejunostomy were placed, followed by deployment of a new 10 mm × 10 cm uncovered biliary stent through the existing one. Despite technical success, the patient's functional decline continued. Due to poor performance status and metastatic burden, chemotherapy was not pursued. He was transitioned to hospice after goals-of-care discussions. Discussion: This case underscores the diagnostic and therapeutic challenges of managing advanced gallbladder adenocarcinoma in a patient with Prader-Willi syndrome. The patient developed malignant biliary and gastric outlet obstruction, requiring dual endoscopic palliation, including EUS-guided gastrojejunostomy—a novel approach aimed at improving quality of life. Multidisciplinary collaboration was critical in balancing the procedural risks, disease progression, and overall goals of care. EUS-guided interventions may serve as valuable tools in managing complex gastrointestinal obstruction in select patients with limited options.
Figure: EUS and ERCP confirmed a malignant-appearing 8.5 cm gallbladder mass with bulky para-aortic and gastrohepatic lymph nodes.
Figure: Repeat ERCP revealed complete biliary stent occlusion. A duodenal stent and EUS-guided Gastrojejunostomy was placed, followed by deployment of a new 10 mm × 10 cm uncovered biliary stent through the existing one.
Disclosures: Sunny Kumar indicated no relevant financial relationships. Rahul Kumar indicated no relevant financial relationships. Ashok Kumar indicated no relevant financial relationships. Avinash Nankani indicated no relevant financial relationships. Archit Garg indicated no relevant financial relationships. Vikash Kumar indicated no relevant financial relationships. Hany Eskarous indicated no relevant financial relationships. Aman Ali indicated no relevant financial relationships.
Sunny Kumar, MD1, Rahul Kumar, MD2, Ashok Kumar, MD3, Avinash Nankani, MBBS4, Archit Garg, MD5, Vikash Kumar, MD6, Hany Eskarous, MD7, Aman Ali, MD8. P1424 - Malignant Gallbladder Adenocarcinoma in a Patient With Prader-Willi Syndrome: A Complex Case of Obstructive Jaundice and Gastric Outlet Obstruction Requiring Palliative Gastrojejunostomy, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
