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PubMed1977

Occurrence of disseminated intravascular coagulation (DIC) in obstructive jaundice and its relation to biliary tract infection.

Coagulation studies were done on 78 consecutive cases of obstructive jaundice with or without biliary tract infection. Among 26 cases with biliary tract infection 20 cases showed no bleeding tendency but remarkable hypercoagulability with decreased fibrinolytic activity. Other six cases developed diffuse bleeding tendency in addition to the signs of hypotension and multiorgan dysfunction such as oliguria, respiratory distress and mental confusion. Most showed marked coagulation defects characterized by thrombocytopenia, decreased fibrinogen, antithrombin III and plasminogen levels and narrowing of maximal amplitude in thrombelastogram as well as the increase of fibrin degradation products and positive soluble fibrin monomer complexes. All except one died and three cases were autopsied. In two cases postmortem examination revealed multiple fibrin thrombi in lungs and other organs. A cause of the development of bleeding tendency in obstructive jaundice presently observed may likely to be due to the occurrence of disseminated intravascular coagulation (DIC), i.e. hypercoagulability caused by the biliary tract infection is responsible.

Adult↗
PubMed1980

Metastatic carcinoma of the breast: a cause of obstructive jaundice.

Two cases of jaundice are reported that were secondary to obstruction of the common bile duct by metastatic carcinoma of the breast and relieved by pallieative surgery. In one case, obstructive jaundice was the first evidence of spread beyond regional lymph nodes, in the other patient it was a late manifestation of the disease. In patients with prior history of carcinoma of the breast, jaundice may be secondary to obstruction of the common bile duct, and, because it is amenable to palliation, this possibility should be investigated before concluding that extensive hepatic involvement is the cause of jaundice.

Breast Neoplasms↗
PubMed1989

Modulation of immunosuppression in obstructive jaundice by Tinospora cordifolia.

A clinical study was undertaken to determine the immune status of patients with obstructive jaundice. Screening of 16 patients for phagocytic and microbicidal activity of polymorphonuclear cells (PMN) revealed a significant depression (21.2 +/- 3.7% phagocytosis and 20.85 +/- 4.5% intracellular killing) of these functions, as compared to normal values (30.37 +/- 5.1% and 26.41 +/- 4.3% respectively). An animal model of cholestasis was also established, using rats, in which a significant depression of activity of PMN and peritoneal macrophages was observed. These cellular abnormalities were found to precede and predispose to infection. The rats also showed an increased susceptibility to Escherichia coli infection (mortality rate 77.78%). A defect was detected in their serum responsible for depressing the function of phagocytic cells. An attempt was made to improve this immunosuppression by treating the rats with water extract of T. cordifolia 100 mg/kg for 7 days, following development of cholestasis. The extract improved the cellular immune functions. Mortality rate following Esch. coli infection was significantly reduced to 16.67 per cent. This study showed that cholestasis results in immunosuppression and therefore indicates the need for an immunomodulator in management of obstructive jaundice. The plant T. cordifolia seems to meet this need by consolidating host defence mechanism.

Adult↗
PubMed1981

[Obstructive jaundice of benign and malignant origin: endoscopy in diagnosis and therapy].

Laparoscopy and laparoscopic cholecysto-cholangiography for diagnosis of obstructive jaundice have been superseded by ERCP. ERCP is indicated in all patients with bilirubinaemia over 2 mg%. Surgery for obstructive jaundice should be abandoned in favour of surgery for common bile duct concretion, benign or malignant stenosis or periampullary neoplasia, as diagnosed by ERCP. Endoscopic sphincterotomy (EST) for recurrent common bile duct concretion is preferred in patients more than 60 years old. Biliary drainage techniques for litholysis or palliative tumour therapy have widely enlarged the spectrum of endoscopic surgery.

Adult↗
PubMed1976

Endotoxaemia and renal failure in cirrhosis and obstructive jaundice.

An investigation into the possible role of endotoxins in the pathogenesis of renal failure in cirrhosis and obstructive jaundice showed the two to be closely related. None of the patients with cirrhosis who had endotoxaemia had other evidence of Gram-negative infection at the time of the study, and the endotoxaemia was therefore probably due to impaired hepatic clearance of toxins normally absorbed from the gastrointestinal tract. In contrast, bacteriological evidence of Gram-negative infection was found in most of the patients with obstructive jaundice and endotoxaemia.

Adult↗
PubMed1983

Heterotopic pancreas mimicking carcinoma of the head of the pancreas: a rare cause of obstructive jaundice.

A 61-year-old man developed obstructive jaundice and had ultrasonographic and cholangiopancreatographic findings consistent with carcinoma of the pancreas. However, pathologically the obstruction proved to be from heterotopic pancreatic tissue compressing the common bile duct. This patient and eight previously reported patients with a similar problem are the subjects of this report.

Adult↗
PubMed1997

Impaired response of gastric vessels to prostaglandin E2 in rats with persistent obstructive jaundice.

We investigated the response of gastric vessels to prostaglandin (PG) E2 after intra-duodenal release of bile in rats with obstructive jaundice. The animals were divided in four groups according to duration of bile duct obstruction (BDO): control and 1 week (W), 2W, and 3W groups. Prolonged BDO decreased gastric mucosal blood flow (BF) significantly. The BF recovered after the release of BDO in the 1W and 2W groups, but not in the 3W group. BDO decreased PGE2 content in gastric mucosa in the 1W, 2W, and 3W groups. PGE2 decreased vascular perfusion pressure of the isolated stomach in the control and 2W groups, but not in the 3W group. The response of gastric vessels to PGE2 was poor in the 3W group compared with the control and 2W groups. Decreased PGE2 in the gastric mucosa and decreased response of gastric vessels to PGE2 may affect gastric blood flow in obstructive jaundice.

Animals↗
PubMed2006

Obstructive jaundice caused by secondary pancreatic tumor from malignant solitary fibrous tumor of pleura: a case report.

A 77-year-old man on systemic chemotherapy against postoperative bilateral multiple lung metastases of malignant solitary fibrous tumor of the pleura suffered from pruritus and jaundice. Blood examination showed elevated levels of hepatobiliary enzymes. Abdominal computed tomography showed a tumor with peripheral enhancement in the pancreatic head, accompanied with the dilatation of intra- and extra-hepatic bile ducts. He was diagnosed as having obstructive jaundice caused by a pancreatic head tumor. The pancreatic head tumor was presumably diagnosed as the metastasis of malignant solitary fibrous tumor of the pleura, because the findings on the pancreatic head tumor on abdominal CT were similar to those on the primary lung lesion of malignant solitary fibrous tumor of the pleura. The pancreatic tumor grew rapidly after the implantation of metallic stent in the inferior part of the common bile duct. The patient died of lymphangitis carcinomatosa of the lungs. Autopsy revealed a tumor that spread from the pancreatic head to the hepatic hilum. Microscopically, spindle-shaped cells exhibiting nuclear atypicality or division together with collagen deposition were observed. Immunohistochemically the pancreatic head tumor cells were negative for staining of alpha-smooth muscle actin (alpha-SMA) or CD117, but positive for vimentin, CD34 and CD99. These findings are consistent with those on malignant solitary fibrous tumor of the pleura. We report the first case of obstructive jaundice caused by a secondary pancreatic tumor from malignant solitary fibrous tumor of the pleura.

Aged↗
PubMed1985

IgA containing circulating immune complexes and IgA anti-single stranded DNA antibodies in patients with obstructive jaundice.

Elevated levels of IgA containing circulating immune complexes (IgA-CIC) and IgG containing (IgG-) CIC were detected in patients with obstructive jaundice due to biliary tract stones and/or tumour of biliary tract or pancreas. Levels of serum IgA were also elevated, and correlated with the levels of IgA-CIC. The levels of IgA and IgG anti-single stranded (ss) DNA were elevated, and there was a significant correlation between the levels of IgA-CIC and IgA anti-ssDNA antibodies. The cause of IgA-CIC increase in patients with obstructive jaundice might be due not only to simple obstruction of biliary tract but also to other factors such as a tissue destruction.

Adult↗
PubMed1999

Obstructive jaundice and acute cholangitis due to papillary stenosis.

Papillary stenosis is characterized by fixed fibrosis leading to structural outflow obstruction and it is usually secondary to inflammation and fibrosis from the chronic passage of gallstones, episodes of acute pancreatitis, chronic pancreatitis, sclerosing cholangitis, peptic ulcer disease, and cholesterolosis. However, obstructive jaundice with or without acute cholangitis which leads the physician to suspect the presence of malignancy as a cause is a rare manifestation of papillary stenosis. We report here a case of papillary stenosis presenting with obstructive jaundice and acute cholangitis. The lesion was so difficult to exclude the presence of malignancy preoperatively and intraoperatively that a pylorus-preserving pancreaticoduodenectomy was performed. Histologic examination of the resected specimen revealed fibrosis, adenomatoid ductal hyperplasia, and mild chronic inflammation of the papilla of Vater and distal common bile duct.

Acute Disease↗
PubMed2006

Xanthogranulomatous cholangitis causing obstructive jaundice: a case report.

This article reports the case of a 34-year-old woman with xanthogranulomatous cholangitis who developed obstructive jaundice. Microscopically, the bile duct was surrounded and narrowed by a xanthogranulomatous lesion, but no xanthogranulomatous cholecystitis was seen. Although percutaneous cholangiograms done via the transhepatic biliary drainage showed smooth narrowing of the upper to middle bile duct, the cytology of bile was diagnosed as class V adenocarcinoma. Therefore, right extended hepatectomy and extrahepatic bile duct resection were performed. The differentiation of benign and malignant strictures at the hepatic hilum is often difficult. Xanthogranulomatous cholangitis is one possible diagnosis of a bile duct stricture. Precise review of all the preoperative information is required to make a correct diagnosis.

Adenocarcinoma↗
PubMed1992

[Endoscopic sonography in extrahepatic obstructive jaundice].

In a prospective study, 37 patients (20 women, 17 men, mean age 75 [41-93] years) with extrahepatic obstructive jaundice were investigated, within 24 hours of admission, by transcutaneous ultrasound (US), endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). EUS was always performed after US and immediately before ERCP, and the findings were recorded without any knowledge of the results of ERCP (the 'gold standard'). Dilatation of the common bile duct was demonstrated by all three methods. Concretions in the distal common bile duct causing obstructive jaundice were demonstrated by EUS in 15 out of 16 cases, but in only seven cases by US. All 21 cases with an underlying malignant cause were correctly diagnosed by EUS and ERCP, and the level of the biliary obstruction was accurately determined; using US this was possible in only 15 (70%) and 18 (85%) cases. In comparison with ERCP, which imaged the tumour only indirectly, EUS showed the tumour itself and allowed local and regional staging in all cases. EUS is superior to US for elucidating the cause of biliary outflow obstruction and allows reliable local and regional staging. It is of additional benefit in deciding on appropriate therapy. A disadvantage is the impossibility at present of undertaking surgical therapy during EUS investigations.

Adult↗
PubMed1978

Obstructive jaundice in pancreatitis investigated by percutaneous transhepatic cholangiography.

Obstructive jaundice is a rare complication of alcoholic pancreatitis. In three patients with persistent jaundice, percutaneous transhepatic cholangiography demonstrated either stenosis and dislocation of the common bile duct due to pancreatic pseudocysts or stenosis due to pancreatic fibrosis. These stenoses were easily differentiated from obstructions due to tumours or common duct stones. We suggest that percutaneous transhepatic cholangiography is valuable in pancreatitis with jaundice.

Acute Disease↗
PubMed1992

[Radiation therapy for patients with obstructive jaundice caused by carcinoma of the extrahepatic biliary system].

From February 1980 through September 1990, 92 patients with obstructive jaundice resulting from biliary tract cancer registered at Shikoku Cancer Center Hospital or Ehime University Hospital. Radiation therapy (RT) was used to treat 38 of these patients (30 with carcinoma of the extrahepatic bile duct, excluding ampulla of Vater, and eight patients with carcinoma of the gallbladder). Of 38 patients, 11 underwent intraoperative radiation therapy (IORT), and 27 were treated by external radiation therapy (ERT) alone. In contrast, 54 patients (39 with carcinoma of the extrahepatic bile duct and eight with carcinoma of the gallbladder) were not treated by RT. All jaundiced patients received external and/or internal biliary drainage of some kind. Among patients undergoing biliary drainage with a catheter, 21 patients who underwent RT (four with IORT) survived significantly longer than 19 patients who did not (generalized Wilcoxon test: p less than 0.05). There were no significant differences in survival between 7 patients with recanalization and 11 patients with no recanalization. Concerning the survival of laparotomized patients, excluding those with complete resection or perioperative death, eight patients treated with postoperative ERT survived longer than 12 patients who did not have postoperative ERT (not significantly). Eleven patients underwent IORT. A patient with unresectable carcinoma of the hilar bile duct survived 2 years and 3 months after a combination treatment of ERT and IOTR. In four of eight autopsied patients, radiation effects of Grade II were observed (Oboshi and Shimosato's evaluation system for the histological effects of radiation therapy). Our experience suggests that RT is effective in patients with obstructive jaundice caused by carcinoma of the biliary system.

Adenocarcinoma↗
PubMed1997

Protective effect of the intravenous administration of ursodeoxycholic acid against endotoxemia in rats with obstructive jaundice.

This study was undertaken to elucidate the effect of the intravenous administration of ursodeoxycholic acid (UDCA) on endotoxemia in rats with obstructive jaundice from the viewpoint of the biliary excretion of lipopolysaccharide (LPS) through hepatocytes. In rats with obstructive jaundice, fluorescein isothiocyanate-labeled LPS was administered via the portal vein and then its biliary excretion was examined. A significant increase in the LPS excretion was thus noticed in UDCA-treated rats at a dose of 0.1 micromol/100 g body wt. per min. In place of UDCA, sodium taurocholate at the same dose also enhanced the biliary excretion of LPS. Secondly, we also examined whether or not UDCA protects against endotoxemia. In this experiment, nonlabeled LPS was administered via the portal vein and its peripheral concentration was then measured. In UDCA-treated rats, the endotoxin concentration was significantly lower. Finally, to elucidate the effect of UDCA on Kupffer cells, serum tumor necrosis factor (TNF-alpha) was measured. But UDCA had no effect on the TNF-alpha level. These findings thus demonstrate that the intravenous administration of UDCA protects against endotoxemia by enhancing the transport of LPS across the hepatocytes from blood to bile without affecting Kupffer cells, and that this biliary excretion of LPS is dependent on bile acids.

Analysis of Variance↗
PubMed2006

Effect of L-arginine on calcium in hepatic mitochondrion in rats with obstructive jaundice.

BACKGROUND: There is much debate over the regulation of mitochondrial calcium overload and reducing the impairment of energy metabolism in hepatic cells. It has not been reported whether L-arginine (L-Arg) can affect hepatic mitochondrial calcium overload. This study was undertaken to investigate the protective effect of L-Arg on Ca2+ handling of hepatic mitochondrion in rats with obstructive jaundice and to clarify its possible mechanism. METHODS: Seventy-two male SD rats were randomly divided into 3 groups: sham operation+normal saline group (SO group), common bile duct ligation+normal saline group (BDL group), and common bile duct ligation+ L-Arg group (L-Arg group). The levels of malondialdehyde (MDA), superoxide dismutase (SOD) and Ca2+ in rat hepatic mitochondrion were examined at the 7th, 14th and 21st day after operation. RESULTS: The Ca2+ and MDA levels of hepatic mitochondrion increased significantly but their SOD content decreased markedly at each time point in the BDL group. Except at the 21st day, the Ca2+ and MDA, contents of hepatic mitochondrion were significantly lower, and SOD concentrations were higher in the L-Arg group than those in the BDL group at the 7th and 14th day (P<0.01). CONCLUSION: L-Arg has a protective effect on mitochondrion in the early and mid stages of obstructive jaundice.

Animals↗
PubMed2007

[Weekly paclitaxel therapy effective for gastric cancer with obstructive jaundice due to peritoneal dissemination--a case report].

The patient was a 61-year-old man who suffered from advanced gastric cancer, and a distal gastrectomy was performed (T3N2P1CY1, Stage IV). He was treated with chemotherapy of TS-1 alone (100 mg/day, days 1-28 with two weeks rest). Six months later he complained of lumbago and appetite loss, then was admitted to the hospital with obstructive jaundice. Total bilirubin (T-Bil) was increased to 11.3 mg/dl. CT scan examination revealed peritoneal dissemination with much ascites and dilatation of intrahepatic bile ducts. Endoscopic drainage was tried, but was discontinued due to stenosis of gastroduodenal anastomosis. Ultimately, T-Bil was elevated to 25.2 mg/dl, and he could not sleep comfortably because of a severe itch and an irritating feeling. Weekly paclitaxel therapy was started (70 mg/m(2), day 1, 8, 15, once a week for 3 weeks followed by a week rest as one cycle). One month after the first infusion therapy, the obstructive jaundice was notably improved and the ascites disappeared completely, so he was discharged. For about one year, he was treated with this chemotherapy as an outpatient. The toxic events were anemia (grade 3) and alopecia (grade 1).

Antineoplastic Agents, Phytogenic↗
PubMed2004

[Pancreatic tuberculosis: a rare cause of pseudoneoplastic obstructive jaundice].

Isolated pancreatic tuberculosis is rare, and can mimic pancreatic carcinoma. We report a case of pseudoneoplastic pancreatic tuberculosis revealed by an obstructive jaundice in a 35-Year-old man. Surgical pancreatic histopathology showed a caseating granulomatous inflammation and diagnosis was confirmed by detection of Mycobacterium tuberculosis DNA using specific polymerase chain reaction-based assay (PCR). The patient was successfully treated with quadruple antituberculous therapy. In the context of the diagnostic work-up of a hypodense pancreatic mass, the diagnosis of tuberculosis relies on the presence of pancreatic caseating granulomas, that can be obtained by endosonography-guided biopsy, thus avoiding laparotomy.

Adult↗