# Case report: The diagnostic dilemma of indeterminate biliary strictures: report on two cases with a literature review

## TL;DR

This case report discusses two patients with unclear biliary strictures that were later diagnosed as cancer after surgery, highlighting the difficulty in diagnosing such cases.

## Contribution

The paper adds two new case reports to the literature on indeterminate biliary strictures and emphasizes the need for prompt surgical exploration in difficult cases.

## Key findings

- Two patients with indeterminate biliary strictures were confirmed to have malignancies after exploratory surgery.
- Imaging and endoscopic exams failed to provide a diagnosis in these cases.
- The authors stress the importance of multidisciplinary discussions and timely surgical intervention for ambiguous cases.

## Abstract

It is still a challenging problem for clinicians to explore the nature of the indeterminate biliary strictures (IBSs). Approximately 20% of biliary strictures remain undetermined after a thorough preoperative assessment.

Here, we present two cases of indeterminate biliary strictures patients, whose cross- sectional imaging and endoscopic examination were nondiagnostic. The patients underwent exploratory laparotomy finally and were confirmed as malignancy. We also reviewed the recent reports in literatures regarding the evaluation of IBSs.

Given the majority of the biliary strictures are malignancy, preoperative differentiation between benign and malignant is critical for choosing the best therapeutic regimen. Thus, close follow-up, multiple multidisciplinary discussion, and prompt surgical exploration are necessary for some difficult diagnostic cases.