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PubMed2006

Eosinophilic gastroenteritis of the pancreas: an unusual cause of obstructive jaundice.

Eosinophilic gastroenteritis (EG) is a rare gastrointestinal disorder of undetermined etiology and is manifest by eosinophilic infiltration of any area of gastrointestinal tract, most frequently stomach and small intestine. Peripheral eosinophilia is present in about 80% of patients. Definitive diagnosis requires histologic evidence of eosinophilic infiltration; which is usually patchy in distribution. Steroids are the mainstay of treatment. We present a case of 47-year-old man with abdominal pain, jaundice, and marked eosinophilia. Endoscopic retrograde cholangio-pancreatogram revealed a dilated common bile duct. There was biopsy proven eosinophilic infiltration in stomach, duodenum, gall bladder, and pancreas. Obstructive jaundice is an extremely rare manifestation of EG. This unusual case illustrates the wide variety of gastrointestinal manifestations caused by EG and emphasizes the importance of clinical suspicion and endoscopic mucosal biopsies in diagnosis of EG. This entity should be considered in the patients with chronic and relapsing gastrointestinal symptoms.

Bile Ducts, Intrahepatic↗
PubMed2004

Lymphoplasmacytic sclerosing pancreatitis with obstructive jaundice: CT and pathology features.

OBJECTIVE: The clinical presentation of lymphoplasmacytic sclerosing pancreatitis (LPSP) can be very similar to that of pancreatic cancer, with no statistically significant differences in the rates of abdominal pain, weight loss, jaundice, or levels of carcinoembryonic agent or cancer antigen 19-9. The purpose of this study is to describe and illustrate the CT features of LPSP presenting with obstructive jaundice and to correlate CT and pathology findings. MATERIALS AND METHODS: Five patients with LPSP were evaluated. Morphologic features of the pancreas on CT scans, including the size of the pancreas, presence or absence of a mass, segmental difference of contrast enhancement, pancreatic duct, major pancreatic vasculature, and biliary tract, were retrospectively evaluated and correlated with histopathology. The degree of contrast enhancement of the pancreas was compared in 10 patients without LPSP, who were scanned with the same protocol. RESULTS: CT scans showed diffuse (n = 2) or focal (n = 3) enlargement of the pancreatic head. The normal lobular appearance of the pancreas was effaced, and the gland appeared featureless in the involved region. Enlarged areas showed an enhancement pattern similar to that of the rest of the pancreas, and no segmental difference of contrast enhancement was identified. Pancreatic duct dilatation was not seen in any patient. Thickening and contrast enhancement of the common bile duct wall (n = 4) and gallbladder wall (n = 3) were observed and were pathologically correlated with inflammatory infiltrate and fibrosis of the common bile duct (n = 3) and gallbladder (n = 1). CONCLUSION: When these findings are encountered, further evaluation with serologic tests or biopsy may aid in the diagnosis of LPSP.

Aged↗
PubMed1982

Endotoxemia, disturbance of coagulation, and obstructive jaundice.

A prospective study of coagulation disturbances and endotoxemia in 42 patients having major pancreatic or biliary surgery was performed. Endotoxin, soluble fibrin, and fibrin degradation products were measured before and after operation in 28 patients with obstructive jaundice and in 14 nonjaundiced controls. In the control group there was one death and no unexplained fever or postoperative hemorrhage. The jaundiced group had more complications: seven deaths, nine episodes of fever, and six episodes of hemorrhage. Soluble fibrin was detected only in patients with obstructive jaundice, in whom it occurred in 38 percent before operation. Positive endotoxin assay was as common in control patients as in the jaundiced group, but in the latter endotoxin was associated (p less than 0.05) with increased FDP and soluble fibrin. Patients with endotoxin or increased FDP levels before operation for jaundice carry a poor prognosis (7 of 11 died). Preoperative bowel preparation in 16 of the jaundiced patients did not affect the outcome.

Adult↗
PubMed1988

Extrahepatic obstructive jaundice due to colorectal cancer.

A prospective registry of patients with obstructive jaundice referred for percutaneous bile duct drainage found six patients with extrahepatic obstruction due to colorectal cancer in a 21-month period. This cause of jaundice in patients with colorectal cancer is not uncommon, and deserves routine diagnostic consideration, even in the presence of intrahepatic metastases. Percutaneous biliary drainage was beneficial for four of the six patients.

Adenocarcinoma↗
PubMed2004

Duodenal duplicated cyst manifested by acute pancreatitis and obstructive jaundice in an elderly man.

A duodenal duplication cyst is an uncommon congenital anomaly that is usually encountered during infancy or in early childhood. Duodenal duplication cysts generally appear on the first or second portion of the duodenum and may cause duodenal obstruction, hemorrhage or pancreatitis. Here, we report a case of a duodenal duplication cyst on the second and third portion of the duodenum in an old aged man with obstructive jaundice and acute pancreatitis, which was treated successfully by a surgical excision.

Aged↗
PubMed2003

Magnetic resonance-guided biliary drainage in a patient with malignant obstructive jaundice and thrombocytopenia.

In a patient suffering from malignant obstructive jaundice and thrombocytopenia, magnetic resonance imaging (MRI) was used to guide percutaneous transhepatic biliary drainage, to avoid blind puncture of the bile ducts using fluoroscopy. The first puncture approach was successful, and an MRI-visible guide wire and drainage catheter were inserted successfully within 35 min. The course after the intervention was uneventful, and the patient's fever and itching improved. MRI guidance facilitated optimal procedure planning and high puncture accuracy.

Cholestasis↗
PubMed1985

Obstructive jaundice. Diagnostic and therapeutic considerations.

The diagnostic approach to obstructive jaundice must be individualized on the basis of the sensitivity and specificity of the various procedures available. No single diagnostic approach is optimal in all patients. The physician must be guided by knowledge of the yield, complications, and cost of the tests available. In addition, interventional endoscopic and radiologic techniques add a new therapeutic dimension to the standard surgical approach.

Cholangiography↗
PubMed1984

Pancreatic cystadenoma with obstructive jaundice.

A 64-year-old woman with painless obstructive jaundice had a 7 cm mass in the head of the pancreas. At operation and biopsy the mass was found to be benign. It was removed by a Whipple procedure, and the diagnosis of cystadenoma was made. A three-year follow-up has been satisfactory.

Cholestasis↗
PubMed1988

Pharmacokinetics of cefpiramide in rats with obstructive jaundice.

Changes in the mode of drug excretion in obstructive jaundice (OJ) were investigated in rats with experimentally induced OJ using a non-metabolized, highly-biliary-excreted antibiotic, cefpiramide (CPM). In OJ rats, biliary excretion of the drug was markedly diminished, while the urinary excretion was increased. The change in the mode of CPM excretion was examined in detail. It seems that the biliary excretion of CPM was decreased owing to the diminished biliary clearance in OJ rats. On the other hand, CPM binding to plasma proteins was decreased in the disease state. This change in the protein binding would be due to both the decreased albumin concentration and the accumulation of binding inhibitors in the plasma of diseased rats, and the decreased protein binding would be related not only to the increase in the volume of distribution but also to the increase in the renal clearance.

Animals↗
PubMed1992

Surgery for malignant obstructive jaundice: analysis of mortality.

Surgery on patients with malignant obstructive jaundice carries formidable morbidity and mortality rates. Clinical records of 120 consecutive patients who had a serum total bilirubin levels of 100 mumol/L or greater before exploration were analyzed retrospectively to provide guidelines for better management. Although most patients underwent bilienteric bypass to either the extrahepatic (n = 45) or intrahepatic ductal system (n = 28), resection was possible in 32 (26.7%). Complications developed in 42 patients (35%), among whome 12 (10%) required reexploration and 32 (26.7%) died within the same hospitalization. Identification of risk factors associated with hospital deaths after surgery was conducted on 84 of the 120 (group A) patients randomly selected from the entire study period. Based on multivariate analysis, age greater than 65 years, a raised serum aspartate transaminase value greater than 90 IU, and serum urea level greater than 7 mmol/L before surgery were the risk factors selected from 39 different clinical (n = 6), laboratory (n = 26), and operative (n = 7) parameters studied. The predictive value was validated in the remaining 36 patients (group B), and a high-risk patient population had been isolated. Because both serum urea and aspartate transaminase values correlated significantly with the necessity of urgent exploration, aggressive nonoperative treatment should be used to control the emergency. Alternative therapeutic options or perioperative management should be considered for the selected high-risk patients before definitive surgical biliary decompression.

Adult↗
PubMed1991

[Merits, demerits and methods of preoperative biliary drainage for malignant obstructive jaundice].

One hundred twenty-four patients with malignant obstructive jaundice undergoing Whipple's procedure were divided into two groups. Group I, 72 patients with an average preoperative serum bilirubin level of 13.3 mg/dl underwent pancreaticoduodenectomy after the level dropped to 5.88 mg/dl by preoperative external biliary drainage (21 patients with PTCD and 51 with cholecystostomy). Group II, 52 patients with a mean bilirubin level of 7.18 mg/dl received Whipple' procedure without preoperative drainage. There was no significant difference in mortality and morbidity between the two groups. We believed that biliary drainage is essential to patients with severe jaundice, otherwise the mortality and morbidity would be much higher AS to method of biliary drainage, we recommend cholecystostomy in hands not skillful with PTCD.

Ampulla of Vater↗
PubMed1996

Plasma cytokine levels and monocyte activation in patients with obstructive jaundice.

Some monocytic cytokines are important immune regulators. We have investigated cytokine production by monocytes and the blood levels of IL-1 beta, IL-6, TNF alpha, and TGF beta, in patients with obstructive jaundice. The supernatant from LPS stimulated monocytes from jaundiced patients released significantly increased quantities of TNF alpha by both bioassay and radioimmunoassay (RIA) (12.4 +/- 2.5 fmol/mL and 32.6 +/- 8.3 fmol/mL, respectively, for jaundice, compared with 1.6 +/- 0.3 fmol/mL and 2.4 +/- 0.5 fmol/mL respectively for controls, and also of IL-6 (54.8 +/- 5.0 fmol/mL in jaundice compared with 35.6 +/- 5.0 fmol/mL for controls). The production of IL-1 beta and TGF beta by stimulated monocytes was unchanged. Jaundiced patients had significantly higher plasma TGF beta, but TNF alpha and IL-1 beta were below the limits of detection. The highest monocyte TNF alpha and IL-6 levels were seen in malignant disease patients, especially those with a poor immediate prognosis. We conclude that the production of some cytokines by monocytes is up-regulated in patients with obstructive jaundice.

Bile Duct Diseases↗
PubMed1990

[Effect of obstructive jaundice on the electrophysiological characteristics of the gastric mucosa and gastric acid secretion in rats].

To elucidate the effect of jaundice on the electrophysiological characteristics of the gastric mucosa and gastric acid secretion, gastric mucosal potential difference (PD) and gastric acid secretion were measured in rats with obstructive jaundice. Also transepithelial potential difference (TEPD), short circuit current (Isc) and transepithelial electrical resistance (Rt) were measured in the isolated gastric mucosa of rats with obstructive jaundice. Secondly, to confirm whether the alteration of these parameters were induced by jaundice and increased serum bile acids in the jaundiced rats, the effects of biliary drainage on the electrophysiological characteristics and gastric acid secretion, and the effects of bile acid (TCA) on TEPD, Isc, Rt were evaluated. PD, TEPD, Isc and gastric acid secretion were reduced in the jaundiced rats, and tended to recover after biliary drainage. TEPD and Isc were reduced significantly by TCA administration. These results suggest that active ion transport in the gastric mucosal cells and gastric acid secretion are impaired in jaundiced rats and the increased serum bile acid in jaundiced rats may cause these dysfunctions and the impaired active ionic transport function is improved by biliary drainage.

Animals↗
PubMedDate not supplied

Cytokines and acute-phase response markers derangements in patients with obstructive jaundice.

BACKGROUND/AIMS: Prolonged acute-phase response and increase of cytokines have been associated with higher mortality and surgical complications. This study investigated the status of cytokines and acute-phase response markers in patients with obstructive jaundice. METHODOLOGY: Forty-one patients were investigated. Endotoxin, tumor necrosis factor-alpha, interleukin-6, nitric oxide, C-reactive protein, liver enzymes, albumin and percentage of weight loss were determined at admission. RESULTS: Endotoxin, interleukin-6 and C-reactive protein were significantly elevated in both benign and malignant obstructive jaundice. Increased plasma levels of tumor necrosis factor-alpha were only detected in malignant tumors (68 vs. 24 pg/mL; P < 0.001). Patients with positive acute-phase response (C-reactive protein > mean + 2 SD of controls) had greater weight loss (P = 0.02), endotoxin (P = 0.03) and interleukin-6 plasma levels (P = 0.05) than those with no inflammatory response. Prolonged biliary obstruction (> 10 days) was associated with higher weight loss (P = 0.04), tumor necrosis factor-alpha (P = 0.003) and interleukin-6 (P = 0.05) plasma levels. CONCLUSIONS: A prolonged high-grade biliary tract obstruction prompted an increase in endotoxin levels, associated with a positive acute-phase response and cytokine elevation.

Acute-Phase Proteins↗
PubMed1996

Pathophysiological effect of hepatic ischemia and reperfusion after hepatectomy in dogs with obstructive jaundice, focusing on the effect of coenzyme Q10 and styrene-co-maleic acid superoxide dismutase.

The purpose of the present study was to elucidate the effect of hepatic reflow following ischemia on the remnant liver after hepatectomy with occluded hepatic blood inflow in dogs with obstructive jaundice. When 40% hepatectomy was performed with 10-min occlusion of hepatic blood inflow in dogs with obstructive jaundice, the lipid peroxide content in the remnant liver increased significantly, together with a reduction in superoxide dismutase (SOD)-like activity. The levels of endotoxin and beta-N-acetyl hexosaminase (NAH) in peripheral blood also increased. The phagocytic index increased transiently after 30 min, followed by a marked decrease after 3h. Histologically, degeneration and necrosis of the hepatic parenchymal cells were demonstrated, and survival rate at 7 days was only 23.1%. With the administration of coenzyme Q10 (CoQ10) or styrene-co-maleic acid SOD (SM-SOD), these phenomena were significantly inhibited, and the survival rate improved. After hepatectomy, Kupffer cells in the remnant liver were activated by increased endotoxin levels in the portal vein, inducing the production of free radicals, which, in turn, damaged the Kupffer cells by reducing endotoxin clearance. Finally, the impaired functional reserve in the remnant liver provoked liver failure. The administration of CoQ10 or SM-SOD prevented the occurrence of these phenomena triggered by the free radicals generated by Kupffer cells, stimulated by endotoxin in the portal vein.

Animals↗
PubMed1991

[Obstructive jaundice in proximal pancreatitis after sclerosing of a bleeding duodenal ulcer].

Two weeks after successful endoscopic sclerotherapy of a bleeding duodenal ulcer a fifty-year old male patient developed a benign enlargement of the head of the pancreas and obstructive jaundice. He underwent exploratory laparotomy with choledocho-jejunostomy because there was no evidence of malignant disease. The enlargement of the head of the pancreas and obstructive jaundice are considered to be symptoms of a pancreatitis as a complication of the endoscopic sclerotherapy.

Choledochostomy↗
PubMed1988

[Two cases of obstructive jaundice due to advanced gastric cancer with marked response to the intravenous administration of cisplatinum].

Two cases of obstructive jaundice due to advanced gastric cancer were treated with intravenous administration of cisplatinum. The first case was a 46-year-old female who had undergone gastrojejunostomy 5 months earlier because of Borrmann type 3 gastric cancer. The tumor involved the head of the pancreas and a portion of the duodenum with distant intraperitoneal dissemination (S3N3P3H0). She was admitted to Shimodate Municipal Hospital on June 8 because of abdominal pain and jaundice. Her abdomen was distended with ascites, and there was a fist-sized tumor in the lower portion. CT examination revealed that the jaundice was caused by obstruction due to the main tumor. Histologically, the tumor consisted of poorly differentiated adenocarcinoma. Intravenous administration of CDDP (50 mg/body/week X 4), MMC (4 mg/body/week X 4) and FT (400 mg/body/day for 4 weeks) was carried out. After the chemotherapy, the jaundice, abdominal pain and ascites disappeared, and the abdominal tumor had markedly reduced in size which was regarded as PR. The second case was 66-year-old male who had received subtotal gastrectomy and transverse colectomy 16 months ago because of Borrmann type 3 gastric cancer. The tumor comprised well-differentiated adenocarcinoma and infiltrated to the mesentery of the transverse colon with positive lymphnodes (S3N1P1H0, stage IV). This time he was admitted to the hospital because of general fatigue and jaundice. According to CT examination, the common bile duct was obstructed by metastasized lymphnode around the pancreas. He had elevated serum level of total bilirubin (7.7 mg/gl) and CA 19-9 (23,000 U/ml). After the administration of CDDP (50 mg/body/week X 4) and MMC (4 mg/body/week X 4), his complaints disappeared and the serum total bilirubin level and CA 19-9 level returned within normal range. These data suggest that combination chemotherapy using CDDP was effective in these 2 cases.

Adenocarcinoma↗
PubMed1994

Hepatic recovery after biliary drainage in experimental obstructive jaundice complicated by biliary infection.

The effects of an association of biliary infection and bile stasis on the recovery process of the impaired structure and function of the cholestatic liver after biliary drainage were studied in experimental animals. Obstructive jaundice was induced by clamping a tube inserted into the common bile duct of rats, while at the same time Escherichia coli bacteria were introduced into the tube to induce biliary infection. After one week, the biliary obstruction was removed. After 14 days of biliary drainage, the impaired structure and function of the cholestatic liver without biliary infection were remarkably improved, having returned almost to normal, while in the cases with biliary infection, the impairments were far less improved, especially with respect to mitochondrial function. These results suggest that major hepatic surgery should not be employed in patients with obstructive jaundice in the presence of biliary infection and should be delayed until hepatic function has recovered sufficiently after biliary drainage.

Animals↗