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PubMed2002

Endoscopic internal biliary drainage in a child with malignant obstructive jaundice caused by neuroblastoma.

We describe a 13-year-old girl who underwent insertion of a Flexima biliary stent for obstructive jaundice due to compression of the extrahepatic bile duct by an enlarged lymph node secondary to neuroblastoma. This novel endoscopic internal biliary drainage procedure was safe and effective even for a child, and improved her quality of life. We further review other treatment options available for malignant obstructive jaundice in children.

Bile Ducts, Intrahepatic↗
PubMed1986

Can acute cholecystitis produce obstructive jaundice in the absence of choledocholithiasis?

A case is presented of acute cholecystitis that produced extensive ascending, intrahepatic acute cholangitis (sufficient to produce obstructive jaundice of significant degree) without evidence of choledocholithiasis or ductal dilatation.Questions are raised concerning the present accepted clinical classification of both cholangitis and obstructive jaundice.

Acute Disease↗
PubMed2006

A case of multiple hepatic peribiliary cysts which contributed to the obstructive jaundice and led to liver failure at the young man with von Recklinghausen's disease.

We treated a young man with obstructive jaundice, in whom multiple hepatic peribiliary cysts were detected at autopsy. He had been diagnosed with von Recklinghausen's disease in early childhood and had undergone surgery for a ventricular septal defect with massive blood transfusion at the age of 4 years. Examination at the age of 21 revealed prominent splenomegaly and a low platelet count. He underwent splenectomy and liver cirrhosis was confirmed by open biopsy of the liver. He was followed up at a local hospital and was admitted several times. When he was 41 years old, he was transferred to our hospital with severe jaundice and hepatic encephalopathy. Computed tomography showed marked dilation of the intrahepatic bile ducts and liver function tests showed that jaundice was mainly due to an increase of direct bilirubin. Despite endoscopic nasobiliary drainage, plasma exchange, and continuous hemodiafiltration, he died of hepatic failure after 5 days. At autopsy, multiple hepatic peribiliary cysts were found. Although peribiliary cysts have generally been considered to cause no symptoms, this report describes a patient with multiple hepatic peribiliary cysts which appear to have been responsible for the progression of obstructive jaundice.

Journal Article↗
PubMed1981

CT cholangiography: multiplanar reconstruction in obstructive jaundice.

The value of multiplanar reconstruction (MR) in coronal and sagittal planes from axial transverse computed tomography (CT) slices was investigated in cases of obstructive jaundice. The clinical application for this technique lies in its potential to depict the dilated bile duct to the point of obstruction providing a "map" of the biliary tree. We call the technique "CT cholangiography." The images obtained were of good quality in 77.5% of the cases. Coronal planes proved better than sagittal in demonstrating the bile duct. Furthermore, MR added information concerning the cause of obstruction in 27% of the cases. Improvements in technique will refine the method and likely eliminate the need for invasive cholangiography in many cases of obstructive jaundice.

Carcinoma↗
PubMed1993

[Role of oxygen radicals in the pathogenesis of acute gastric mucosal lesion under obstructive jaundice].

In this study we examined the role of oxygen-derived free radicals in the pathogenesis of acute gastric mucosal lesion induced by obstructive jaundice in rats. Rats were divided into 4 groups as follows: control (sham operation), jaundiced (ligation and dissection of bile duct), vagotomized (truncal vagotomy), and vagotomized with jaundice group. The water immersion restraint procedure was performed. The water immersion restraint procedure was performed. The results obtained are as follows: jaundiced group showed significant increase of ulcer index (UI) and significant decrease of gastric mucosal blood flow (GMBF) and gastric mucosal potential difference (PD). However, intragastric pH (pH) was unchanged compared to the control group. Oxygen radical generating system (gastric mucosal XOD activity and thiobarbiturate acid) and oxygen radical scavenging system (gastric mucosal SOD activity and GSH-px activity) were higher than those of control group. Vagotomized group showed significant increase of pH compared to the control group. Oxygen generating system and scavenging system were unchanged compared to the control group. Vagotomized with jaundice group showed depression of UI and improvement of oxygen radical generating system and scavenging system. However GMBF, PD nad pH were unchanged compared to the jaundiced group. These results suggest that oxygen radical play some role in the development of acute gastric mucosal lesion induced by obstructive jaundice.

Animals↗
PubMed1986

Hepatocellular carcinoma presenting extrahepatic obstructive jaundice due to bile duct invasion--clinicopathological study of two cases.

Two rare cases of autopsy and surgery presenting extrahepatic biliary obstruction due to intrabile-duct growth of hepatocellular carcinoma were reported. Clinically obstructive jaundice was predominant in comparison with the other symptoms in both cases. In one autopsy case, hepatocellular carcinoma developed in the right lobe of the cirrhotic liver (posthepatitic). It involved the secondary branch of the right hepatic duct and grew into the common hepatic duct. In the other case of surgical operation, hepatocellular carcinoma, which developed in the posterior portion of the right lobe of the cirrhotic liver (posthepatitic), destroyed the posterior wall of the bifurcation of the bilateral hepatic duct and obstructed the common hepatic duct due to the intraductal cancer growth. From the site of the bile duct invasion or permeation by the tumor, two cases were classified into the peripheral (the former case) and proximal (the latter case) types, respectively. Furthermore, as far as obstructive jaundice is clinically concerned, the possibility should be kept in mind that hepatocellular carcinoma may proliferate into the large bile ducts, apart from that of cholangiocarcinoma or cholelithiasis.

Autopsy↗
PubMed2003

Effects of different drainage procedures on levels of serum endotoxin and tumor necrosis factor in patients with malignant obstructive jaundice.

OBJECTIVE: To assess the influence of different drainage procedures on the levels of serum endotoxin and tumor necrosis factor (TNF) in patients with malignant obstructive jaundice (MOJ). METHODS: The levels of endotoxin and TNF in 46 patients with MOJ were measured before and after cholangiojejunostomy (CJ) or external bile drainage (EBD). RESULTS: In the CJ group, the levels of postoperative serum endotoxin and TNF 10 days after operation were significantly lower than those before operation (P<0.01). In the EBD group, no significant changes were observed in endotoxin and TNF levels before and after operation (P>0.05). No significant differences were seen between the two groups before operation (P>0.05), but the levels of endotoxin and TNF in the CJ group were significantly lower than those in the EBD group after operation (P<0.01). CONCLUSIONS: Cholangiojejunostomy other than external bile drainage can decrease the levels of serum endotoxin and TNF effectively, although both of them are able to release jaundice. Cholangiojejunostomy should be performed as soon as possible for patients with unresectable malignant tumor.

Adult↗
PubMed1994

Obstructive jaundice secondary to ruptured hepatocellular carcinoma into the common bile duct. Surgical experiences of 20 cases.

BACKGROUND: Hepatocellular carcinoma (HCC) presenting as obstructive jaundice caused by floating tumor debris in common bile duct is rare. Taiwan has a high incidence of HCC and cirrhosis. The authors report their clinical experiences and evaluate the results of different treatment modalities for this disease. METHODS: A retrospective study was undertaken to review 20 patients with obstructive jaundice secondary to ruptured HCC into common bile duct during the 12 years period. RESULTS: All patients on initial examination had recurrent episodic jaundice or cholangitis. Jaundice was relieved by nonsurgical, percutaneous transhepatic biliary stenting in 4 patients and surgical intubation with T-tube drainage in 16. Types of treatment for those who were treated nonsurgically were percutaneous transhepatic biliary stenting in two patients, followed by transcatheter hepatic arterial embolization in another two patients. For the 16 patients who were treated surgically, the types of treatment were T-tube or Y-tube drainage in 11, T-tube drainage followed by hepatic resection in 2, T-tube drainage and hepatic arterial ligation in 1, and T-tube drainage followed by transcatheter hepatic arterial embolization in the other 2. Liver cirrhosis was the associated disease in 12 (75%). Four patients (20%) died in the hospital. The mean survival time for 12 patients with only surgical or nonsurgical biliary stenting was 3.9 months. For the three patients with percutaneous hepatic arterial embolization, the mean survival time was 8.0 months. Two patients who had undergone hepatic resection had a better postoperative survival time, with one surviving for more than 5 years. CONCLUSION: Clinical features, types of management, operative findings, and survival in 20 patients with HCC obstructing the common bile duct by tumor thrombi were reviewed. Not all patients with this disease were terminally ill. With proper management, good palliation and occasional cure are possible.

Adult↗
PubMed1997

Three-dimensional magnetic resonance cholangiopancreatography for evaluation of obstructive jaundice.

The purpose of this study was to assess the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in studying the anatomy, sites, and causes of obstructive jaundice. From September 1994 to May 1996 three-dimensional MRCP was performed on 31 patients with abdominal pain and obstructive jaundice with a fast spin-echo T2-weighted pulse sequence. The images were reconstructed using maximal intensity projection, AVERAGE and SURFACE algorithm processing techniques at a graphics workstation. All the reconstructed images were compared with those obtained using conventional cholangiographic techniques, such as endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography and drainage, and intraoperative cholangiography. The patients' diagnoses included choledochal cyst (13), cholangiocarcinoma (five), choledocholithiasis (four), pancreatic head carcinoma (three), rhabdomyosarcoma (one), papillary Vater carcinoma (one), recurrent gastric carcinoma (one), ascaris (one), and biliary atresia (two). Extrahepatic biliary dilatation was present in all 13 patients with choledochal cyst; the pancreatic ducts and their entrance level to the common bile duct were observed in eight of these patients. The level of obstruction in patients with cholangiocarcinoma was well documented but the biliary tract of one patient with biliary atresia was not identified by MRCP. In one patient with biliary rhabdomyosarcoma, MRCP clearly delineated the extrabiliary extension of the tumor. In a patient with ascaris in the common bile duct an increase in signal intensity inside the digestive tract of the worm denoted fluid in its gut. Lithiasis was shown in all of the four patients with choledocholithiasis. Thus, MRCP is a useful tool in the assessment of biliary tract obstruction and its causes, and is a valuable addition to ultrasonography.

Adolescent↗
PubMed1991

Prevention of postoperative renal dysfunction in patients with obstructive jaundice: a comparison of mannitol-induced diuresis and oral sodium taurocholate.

The effect of oral sodium taurocholate was compared with that of intravenous mannitol when used independently to determine their relative effect on protecting postoperative renal function in patients with obstructive jaundice. A total of 20 patients with obstructive jaundice were randomized to receive either mannitol or sodium taurocholate before surgery. Their preoperative and postoperative renal function was monitored using serum creatinine and predicted creatinine clearance over a 4-day period. There was no difference in postoperative renal function between the two groups and no patient from either group suffered significant renal dysfunction.

Acute Kidney Injury↗
PubMed2006

Successful cystic fenestration for a macrocystic serous cystadenoma of the pancreas causing obstructive jaundice: report of a case.

A 72-year-old man was admitted to our hospital for investigation of jaundice. We made a preoperative diagnosis of macrocystic serous cystadenoma (SCA) of the pancreas, but did not perform palliative choledochojejunostomy because aspiration of the pancreatic cystic fluid caused the cysts to shrink and relieved the compressive stenosis of the common bile duct (CBD) during the operation. Frozen sections of the cyst wall taken by incision biopsy showed no signs of malignancy. Therefore, we performed fenestration of the cystic wall after fixing the inner epithelium of the cyst with 100% ethanol and aspirating the cystic fluid. Cholangiography after the cystic fenestration showed resolution of the CBD stenosis and abdominal computed tomography (CT) confirmed the disappearance of the pancreatic cysts. No recurrence of cystic swelling or obstructive jaundice has been detected by abdominal CT or laboratory data for more than 2 years since the cystic fenestration. Thus, cystic fenestration may be a better palliative option for treating benign compressive tumors such as macrocystic SCA of the pancreas causing obstructive jaundice.

Aged↗
PubMed2000

Successful treatment of percutaneous transhepatic papillary dilation in patients with obstructive jaundice due to common bile duct stones after Billroth II gastrectomy: report of two emergent cases.

Successful treatment of two patients with obstructive jaundice due to choledocholithiasis after Billroth II gastrectomy was performed by elimination of stones by percutaneous transhepatic balloon dilatation of the sphincter of Oddi. Patient 1 was an 82-year-old man and Patient 2 was a 73-year-old man. Both patients presented with obstructive jaundice. The papilla was not observed in either patient because of previous Billroth II gastrectomy. Because an endoscopic approach was impossible, percutaneous transhepatic cholangiodrainage (PTCD) was performed to alleviate jaundice. Choledocholithiasis was treated as follows: The sphincter of Oddi was dilated by percutaneous transhepatic balloon, and stone particles were removed from the papilla with a stone-eliminating balloon catheter via the same route of PTCD. This method is less invasive than the percutaneous transhepatic cholangioscopic method, and the use of existing appliances such as a balloon for papillary dilation is possible. Hence, this method appears to be an effective and simple method for the treatment of choledocholithiasis after gastrectomy that is difficult to treat endoscopically.

Aged↗
PubMed2003

The effects of dimethylsulfoxide in experimental obstructive jaundice.

MATERIAL AND METHODS: Thirty rats were divided into three groups, as sham, control and DMSO groups. Laparatomy was performed on each animal in the control and DMSO groups and common bile ducts were ligated. Common bile duct was observed but was not ligated for the rats in the sham group. Saline solution injection (1.5 mg/kg/intraperitoneally (i.p.)) was begun on the first day of surgical procedure and repeated once a day for the next 5 days. The same procedure was performed with DMSO (1.5 mg/kg/i.p.) instead of saline in the DMSO group. The rats were sacrificed on the postoperative seventh day, at which time venous blood and liver tissue specimens were taken. MAIN OUTCOME MEASUREMENTS: On the 7th postoperative day, the bilirubin, AST, ALT, ALP and GGT levels of the control and DMSO groups were significantly higher in comparison with the sham group (p < 0.01). On the 7th postoperative day, the erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) levels of the control and DMSO groups were significantly lower than those of the sham group (p < 0.01), but there was no statistical difference between the two groups (p > 0.05). Erythrocyte and liver malondialdehyde (MDA) levels in the control and DMSO groups were significantly higher compared with the sham group (p < 0.01). However, the MDA levels were significantly lower in the DMSO group compared to the control group (p < 0.01). CONCLUSION: It is stated that free oxygen radicals seem to play a role in the liver tissue injury, secondary to obstructive jaundice. In our experimental study, exogenic DMSO seems to have decreased lipid peroxidation and to have improved some of the parameters of liver tissue injury due to the obstructive jaundice in rats.

Animals↗
PubMedDate not supplied

Obstructive jaundice caused by lymphangitis carcinomatosa of bile duct wall from gastric carcinoma.

We report a case of advanced gastric carcinoma presenting with obstructive jaundice. Computed tomography showed marked lymphadenopathy in the hepatoduodenal ligament and concentric bile duct wall thickening. Histologically, extrahepatic bile duct wall was thickened due to submucosal lymphangitic spread of gastric carcinoma (lymphangitis carcinomatosa). Lymphangitis carcinomatosa may be considered when extrahepatic bile duct wall thickening is seen in patients with obstructive jaundice.

Adenocarcinoma↗
PubMed1994

A case of chronic pancreatitis with pseudocysts complicated by infection and obstructive jaundice.

We report a case of chronic pancreatitis with pseudocysts complicated by infection and obstructive jaundice. A 49-yr-old male was admitted with the complaints of fever and jaundice. Laboratory findings included high biliary tract enzyme values and normal serum amylase value. Ultrasonography and computed tomographic scan demonstrated a cyst, 4 cm in diameter, in the pancreas head. Cholangiography revealed a long, tapered obstruction of the common bile duct which was apparently compressed by the cyst. Although the jaundice improved after percutaneous transhepatic biliary drainage, fever continued, and the cyst was aspirated. Bacteriological examination of the contents revealed infection. The symptoms disappeared rapidly and the cyst decreased in size soon after aspiration. The stenosis of the common bile duct showed improvement for several weeks but then regressed. In a patient with secondary pancreatic infection or obstructive jaundice following pancreatic disease, distinguishing the condition is an important aspect of accurate diagnosis and therapy.

Cholestasis↗
PubMed2001

[The effect of salvia miltiorrhiza and shengmai on inflammatory mediator and renal function of post-operative patients with obstructive jaundice].

OBJECTIVE: To investigate the effect of salvia miltiorrhiza and shengmai (SS) on inflammatory mediator and renal function in patients with obstructive jaundice (OJ). METHODS: This study included three groups: the OJ patients receiving SS for 6 days after operation (the SS group, n = 15); the OJ patients not receiving SS (the OJ group, n = 15); the patients with other hepato-biliary disorders (the Non-OJ group, n = 15). The levels of ET, LPs, TNF-alpha, IL-6, IL-8 and urine RBP, TFR, ALB were measured one day before operation and 1, 4, 7 days after operation. RESULTS: The SS group's LPs, TNF-alpha, IL-6, IL-8, ET, RBP, TFR and ALB levels were obviously lower on Day 7 after operation as compared with those on Day 1 after operation (P < 0.05). The urine RBP and ALB levels were significantly lower in the SS group than in the OJ group (P < 0.05). CONCLUSION: The post-operative use of salvia miltiorrhiza and shengmai for patients with obstructive jaundice may effectively decrease the postoperative levels of plasma LPs, ET, TNF-alpha, IL-6 and IL-8. At the same time, salvia miltiorrhiza and shengmai may protect renal function by inhibiting inflammatory mediator and improving blood dynamics.

Adult↗
PubMed2001

Effect of granulocyte-macrophage colony stimulating factor on bacterial translocation after experimental obstructive jaundice.

OBJECTIVE: To investigate the effects of granulocyte-macrophage colony stimulating factor (GM-CSF) on bacterial translocation promoted by obstructive jaundice. DESIGN: Controlled animal study. SETTING: University hospital, Turkey. ANIMALS: 30 male Wistar albino rats. INTERVENTIONS: The first group (n = 10) was the sham operation (control) group, and the second and the third (n = 10 each) had common bile duct (CBD) ligation and division under sterile conditions. The third group were also treated with GM-CSF 200 ng subcutaneously daily between the fifth and ninth postoperative days. All animals were killed on the tenth day, and evaluated biochemically and histopathologically. Mesenteric lymph nodes were cultured under aerobic conditions. MAIN OUTCOME MEASURES: Biochemical analysis, histopathological evaluation, and aerobic cultures. RESULTS: There was no bacterial translocation in either the control or GM-CSF groups, whereas Escherichia coli and Salmonella typhimurium were found in 4 and 2 animals, respectively in the ligation group. Although no aerobic bacteria was found in controls and the GM-CSF groups, bacterial translocation was 6/10 in the ligation alone group (p <0.01). CONCLUSION: Activation of inflammatory response with GM-CSF is highly effective in prevention of bacterial translocation in obstructive jaundice.

Animals↗
PubMed1991

[Studies on pruritus in obstructive jaundice cases with special references to serum bile acid fractions].

About, 22 cases with pruritus and 18 cases without pruritus of obstructive jaundice, serum bile acids were analysed quantitatively by high performance liquid chromatography (HPLC) before and after biliary decompression for the study on the relationship between pruritus and non-pruritus group. Analysis was also carried out on 11 cases with normal liver function as the control group. And 15 kinds of bile acids were as followed: unconjugates (ursodeoxycholic: UDCA, cholic: CA, chenodeoxycholic: CDCA, deoxycholic: DCA, lithocholic acid: LCA), glycine conjugates (Gly-UDCA, Gly-CA, Gly-CDCA, Gly-DCA, Gly-LCA) and taurine conjugates (Tau-UDCA, Tau-CA, Tau-CDCA, Tau-DCA, Tau-LCA). Data was analysed by t-test statistically. [I] Before biliary decompression (1) No significant difference was observed between the pruritus group and non-pruritus group about total bile acid level, total unconjugates level and CA/CDCA ratio. (2) On total glycine-conjugates level the pruritus group was significantly lower than the non-pruritus group, that level was about 3/5. Similarly on Gly-CA level was about 2/3, on Gly-CDCA level was about 1/2. (3) By contraries on total taurine-conjugates level the pruritus group was significantly high as compared with the non-pruritus group, that level was about two times. Similarly on Tau-CA and Tau-CDCA levels were about two times. (4) From there results on glycine/taurine ratio (G/T) of total bile acids pruritus group was significantly low as compared with the non-pruritus group, that level was about 1/3. Similarly on G/T ratio of CA level was about 2/5 and on G/T ratio of CDCA was about 1/3. (5) As for various unconjugates, UDCA level was significantly high in pruritus group as compared with non-pruritus group. [II] After biliary decompression No significant difference was shown in the composition of serum bile acids between the pruritus group and the non-pruritus group. These studies showed that the pruritus in the obstructive jaundice cases stood in a certain relation to the increase of taurine-conjugates, especially taurine-conjugated CA and taurine-conjugated CDCA, moreover increase of unconjugated UDCA.

Aged↗