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PubMed1998

Evidence for accelerated generation of hydroxyl radicals in experimental obstructive jaundice of rats.

We present evidence herein of the accelerated generation of hydroxyl radical (.OH) in the plasma and the liver tissue of common bile duct ligated (CBDL) rats, a model for experimental obstructive jaundice. .OH production in the plasma was monitored in vivo by the identification of dihydroxybenzoates in plasma [2,3-dihydroxybenzoate (2,3-DHB) and 2,5-dihydroxybenzoate (2,5-DHB)] using high performance liquid chromatography (HPLC). The average concentrations of 2,3-DHB and 2,5-DHB produced in the plasma of the controls were 33+/-3 microM and 232+/-34 microM (n = 15), respectively, whereas their respective concentrations increased to 149+/-28 microM and 604+/-88 microM in the CBDL rats (n = 19). Furthermore, we also observed a time-dependent decreasing trend of 2,3-DHB and 2,5-DHB production after surgical removal of the ligation of the experimental animals. In addition, the generation of .OH in the liver tissue was studied by using dimethyl sulfoxide (DMSO) as a molecular probe and measuring the amount of methanesulfinic acid (MSA), the product of the trapping reaction. The net production of MSA in the liver tissue of the control rats was 1.22+/-0.05 O.D. unit/g protein (n = 5), whereas its respective concentration of MSA in the liver tissue of CBDL rats increased to 2.05+/-0.15 O.D. unit/g protein (n = 5). In addition, we showed that CBDL rats receiving a pretreatment of mannitol, an .OH scavenger, resulted in the decreased production of MSA. Electron micrographic study indicated that the most prominent change observed in CBDL rats was the alteration of mitochondria, which were swollen with distorted cristae. Meanwhile, the bile canaliculi were moderately more dilated than that of the controls, and an increased neutrophil peripheral blood count was found in CBDL rats when compared to the controls. Taken together, our data suggest that accelerated generation of .OH in the CBDL rats is obvious and may play a key role in the pathogenesis of liver damage associated with obstructive jaundice.

Animals↗
PubMedDate not supplied

Obstructive jaundice due to internal herniation: a case report and review of the literature.

A 45-year-old man was suffering from abdominal pain and vomiting. He was admitted to our hospital with a diagnosis of ileus and obstructive jaundice. He had undergone Roux-en-Y anastomosis for choledocholithiasis 14 years earlier. A computed tomography scan revealed a dilated afferent loop and dilated intrahepatic bile duct. Upper gastrointestinal examination with contrast medium and percutaneous transhepatic cholangiography showed a high intestinal obstruction around the jejunojejunal anastomosis. The patient underwent laparotomy based on a diagnosis of obstructive jaundice due to ileus. During the operation, he was found to have internal herniation of the small bowel through a rent in the mesentery around the Roux-en-Y anastomosis for choledochojejunostomy. The hernia was reduced, and bowel resection was performed due to stenosis of the afferent loop. Jejunojejunal anastomosis was re-performed and the defect in the mesocolon was closed. Internal herniation after Roux-en-Y anastomosis is a rare sequela, but it should be recognized that this complication can occur after Roux-en-Y anastomosis. For prevention of internal herniation around the Roux-en-Y limb, secure closing of the mesenteric defects is important.

Anastomosis, Roux-en-Y↗
PubMedDate not supplied

T-lymphocyte transformation in experimental obstructive jaundice: the role of serum-suppressive factors.

Infective complications are a significant problem in the management of patients with obstructive jaundice, despite the widespread use of prophylactic antibiotics. The cause of this may be suppression of the immune system. This study investigates the effect of serum from an animal model of extrahepatic biliary obstruction (BDL) for 7, 14, and 21 days on the lymphoproliferative response of a single population of T-lymphocytes to the mitogen phytohemagglutinin (PHA). Mean stimulation counts for lymphocytes cultured with 7 days with BDL serum (938 +/- 90 p = 0.04) and for 21 days with BDL serum (844 +/- 253 p = 0.04) are significantly lower than control serum (2382 +/- 1340). The effect of 14 days BDL serum has some suppression of lymphocyte stimulation but this is not significant (1115 +/- 429 p = 0.06). There was no significant correlation with any clinical parameters including bilirubin and the duration of jaundice. We have concluded that serum from animals with obstructive jaundice is immunosuppressive, but further studies are required to identify the factor and its role in vivo.

Animals↗
PubMed1979

Combined fine needle percutaneous transhepatic cholangiography and hypotonic duodenography in obstructive jaundice.

The information obtained at percutaneous transhepatic cholangiography in patients with obstructive jaundice is not always conclusive about the nature of the obstructing lesion. Hypotonic duodenography performed immediately after transhepatic cholangiography may assist in such cases by demonstrating the presence or absence of duodenal involvement. This ensures that the appropriate surgical procedure can be planned before operation. Our experience using the combined techniques in nine patients is reported.

Aged↗
PubMed1993

Relief of malignant obstructive jaundice by endoscopic or percutaneous insertion of metal stents.

From January 1990 through July 1992 we attempted to treat 42 patients (21 men, 21 women; mean age 69 +/- 2 years) with obstructive jaundice due to inoperable malignant biliary obstructions with insertion of metal stents. 67% of the patients had stenoses of the distal common bile duct, 5% of the proximal common bile duct, and 28% had hilar lesions. Obstructions were due to pancreatic cancer (47%), gallbladder cancer (13%), cholangiocarcinoma (20%), and lymphoma of metastatic cancer (20%). We inserted a total of 51 Wallstents and 17 Strecker Stents with a technical success of 100%. The functional success was 95%. The mean bilirubin level decreased from 18.2 +/- 1.7 mg/dl before to 1.5 +/- 0.2 after stent insertion. In the first 30 days one patient (2%) with hilar malignancy developed an early reobstruction due to tumor bleeding and debris. The 30-day mortality rate was 2%. 2 (5%) patients developed recurrent jaundice within the 3-month follow-up period; 1 had tumor overgrowth of the metal stent, 1 had tumor ingrowth through the mesh. Metal biliary endoprotheses offer sufficient initial relief of malignant obstructive jaundice with reduced morbidity and mortality compared to the placement of conventional plastic stents. However, the long-term results are impaired by stent occlusion due to tumor ingrowth or overgrowth.

Aged↗
PubMed1982

Urinary monohydroxy bile acids in young infants with obstructive jaundice.

Using an aluminum oxide column, we fractionated and quantitatively determined urinary monohydroxy bile acids in young infants. For comparison purposes, monohydroxy bile acids were also measured in urine from older children and adults with obstructive jaundice. Lithocholic acid was not found in any specimens of the young infants examined, while 3 beta-hydroxy-5-cholenoic acid was detected in all. In the biliary atresia group, 3 beta-hydroxy-5-cholenoic acid excreted was 0.45+/-0.28 mumol per day (n=7), and in the neonatal hepatitis group, 0.48+/-0.44 mumol per day (n=9). The mean rate of 3 beta-hydroxy-5-cholenoic acid to total urinary bile acids in the biliary atresia group was 2.1%, and 1.3% in the neonatal hepatitis group. In the older children and adults with obstructive jaundice (n=6), 3 beta-hydroxy-5-cholenoic acid was excreted at a mean rate of 3.9% of total urinary bile acids, ranging from 0.63 to 14.81 mol per day. The excretion rate of 3 beta-hydroxy-5-cholenoic acid was related to that of chenodeoxycholic acid (p less than 0.05) in infants, while it was related to that of both chenodeoxycholic acid (p less than 0.01) and cholic acid (p less than 0.05) in older children and adults.

Adult↗
PubMed1998

[Two patients with obstructive jaundice due to intra-abdominal lymph-node metastases of gastric cancer responding to combination chemotherapy with 5-FU and CDDP].

Combination chemotherapy with 5-FU and CDDP was given to two patients with obstructive jaundice due to intra-abdominal lymph-node metastases of advanced and recurrent gastric cancer. One patient was a primary case associated with lymph-node metastases of portal fissure and periaorta, and the other was a recurrent case associated with lymph-node metastases of hepatoduodenal ligament and periaorta. The regimen consisted of 5-FU 1,000 mg/ m2 (day 1-5, continuous infusion) and CDDP 100 mg/m2 (day 3, 1 hr drip infusion). The interval was from the 6th to 21st day. The response to chemotherapy showed shrinking of intra-abdominal lymph-nodes and reopening of the biliary tract. The patients could be discharged from the hospital without PTBD tube and enjoyed a better quality of life (QOL). This therapy is thought to be effective against obstructive jaundice due to intra-abdominal lymph-node metastases of advanced and recurrent gastric cancer.

Abdomen↗
PubMed1976

Obstructive jaundice and renal masses.

An 82-year-old patient with obstructive jaundice secondary to simple renal cyst also suffered pain and vomiting from partial duodenal obstruction. The symptoms were relieved by aspiration of 1,750 ml of fluid. This reaccumulated over a five-year period when aspiration again relieved his symptoms, which then only consisted of epigastric fullness. Review of the literature shows jaundice to be an extremely rare symptom of renal cyst.

Aged↗
PubMed1987

Experience with a combined percutaneous and endoscopic approach to stent insertion in malignant obstructive jaundice.

A non-operative method of palliation in malignant obstructive jaundice was used in 14 patients in whom a biliary stent could not be placed endoscopically. A guide wire was manipulated through the obstructing lesion through the percutaneous transhepatic route and retrieved through an endoscope. The stent was then fed through the endoscope over the guide wire and across the biliary stricture. There were no early complications, and worth-while palliation was obtained in most cases. The success rate for placing an endoscopic stent increased in this unit from 69 to 97% with the introduction of this technique.

Aged↗
PubMed1997

Recovery of portal blood flow after percutaneous transhepatic biliary drainage in patients with obstructive jaundice.

Using an ultrasonic Doppler system, we prospectively studied the changes in portal venous flow (PVF) following percutaneous transhepatic biliary drainage (PTBD) and evaluated the correlation between PVF and liver function in 10 patients with obstructive jaundice. The patients were divided into two groups according to their rate of decrease in serum bilirubin ("b"). Group A comprised 5 patients with a "b" of less than -0.1, while group B consisted of 5 patients who did not meet this criterion. The mean PVF increased following PTBD (P < 0.01). The increase in PVF was due to an increase in the maximum velocity of the portal vein (Vmax). The rate of increase in the Vmax in group A was significantly higher than that in group B on both the 7th and 14th postdrainage days (P < 0.05). The rate of increase in the Vmax correlated significantly with the rate of decrease in the serum bilirubin concentration (P < 0.01). Based on the above findings, we conclude that measuring the Vmax by Doppler ultrasonography is useful in evaluating the liver function in patients with obstructive jaundice.

Aged↗
PubMedDate not supplied

Endotoxin challenge causes a proinflammatory state in obstructive jaundice.

The aim of this study was to investigate the relationship between the obstructive jaundice-induced cellular immune suppression and endotoxin challenge with respect to the levels of tumor necrosis factor (TNF), interleukin-10 (IL-10), and interleukin-2 (IL-2). Rats underwent either bile duct ligation or sham operation. At 21 days, all rats were challenged either with lipopolysaccharide (LPS) or saline. In the sham-operated group LPS injection significantly increased TNF levels at 90 min. The common bile duct ligated group showed a significant increase in TNF levels compared with all other groups, including the sham-operated, LPS-injected group, at 90 min. At 180 min following LPS challenge, TNF levels decreased, and there was no difference between any of the LPS-challenged groups at 180 min and any of the saline groups at either 90 or 180 min. In the sham-operated group, LPS injection significantly increased IL-10 levels at both 90 and 180 min. In the bile duct ligated group, LPS injection significantly increased IL-10 levels compared with saline injection at both 90 and 180 min. On the other hand, bile duct ligated animals had significantly less increase in IL-10 levels following LPS challenge at 90 min but not at 180 min. In common bile duct ligated rats, LPS challenge induced a significantly greater increase in IL-2 levels compared with all other groups. In conclusion, in the presence of obstructive jaundice, endotoxemia primes a more vigorous inflammatory response despite cellular immune depression.

Animals↗
PubMedDate not supplied

Bile cultures and sensitivity patterns in malignant obstructive jaundice.

BACKGROUND: Bactibilia is one of the important factors in the development of postoperative septic complications. We undertook this retrospective analysis to identify the organisms present in bile and their antibiotic susceptibility patterns in patients with malignant obstructive jaundice. METHODS: Bile specimens were obtained during endoscopic cholangiography (ERC; n=65), by flushing biliary stents (n=15), intra-operatively before incising the common bile duct (n=7) or during percutaneous transhepatic biliary drainage (PTBD; n=1). Eighty-eight samples from 65 consecutive patients were analyzed for their bacterial spectrum and sensitivity to antibiotics. Concomitant septic complications such as wound infection and cholangitis were also assessed. RESULTS: Of 65 patients (hilar block 39, distal block 26), 17 (26.1%) had bactibilia at initial ERCP; in addition, 3 of 7 bile specimens obtained during surgery, one collected during PTBD, and 13 of 15 stent flushings grew bacterial organisms. Cholangitis developed in 15 patients (12 with hilar block, 3 with distal block). Blood cultures were positive in 3 cases, and initial bile culture was positive in four patients with cholangitis. The most commonly found organisms were Escherichia coli (36.6%), Klebsiella pneumonia (18.3%), Pseudomonas aeruginosa (8.3%), Proteus vulgaris (8.3%) and coagulase-negative staphylococci (8.3%). The organisms found on ERC were similar to those found at wound cultures in 3 of the 4 cases who developed wound infection. Amikacin, gentamicin, cefotaxime, ceftazidime, and cefoperazone-sulbactam combination showed good activity against E. coli and K. pneumonia. CONCLUSION: Approximately one-fourth of patients with malignant obstructive jaundice have positive bile cultures at initial ERC. Post-ERC cholangitis is common in hilar blocks.

Anti-Bacterial Agents↗
PubMedDate not supplied

Percutaneous palliation of malignant obstructive jaundice with the Wallstent endoprosthesis: follow-up and reintervention in patients with hilar and non-hilar obstruction.

PURPOSE: The authors analyzed the follow-up data of 58 patients with malignant obstructive jaundice who underwent percutaneous palliative treatment with Wallstents over a 4-year period. PATIENTS AND METHODS: Thirty-nine patients had obstruction at the hilar level, and 19 patients had common bile duct obstruction without hilar involvement. Stent patency and survival were calculated with the Kaplan-Meier method. RESULTS: Early complications occurred in 14 patients (24%) and were managed conservatively. There were two procedure-related deaths (3.4%) due to sepsis and pancreatitis, and the overall 30-day mortality was 14%. Forty-eight patients have died, nine patients are surviving (average, 11 months), and one patient was lost to follow-up. Forty-four patients (77%) experienced relief of their initial symptoms, with bilirubin levels returning to normal in 63%. The 12-month patency rate of the endoprostheses was 46% in patients with hilar obstruction and 89% in patients with non-hilar obstruction (P = .029). Late biliary complications were documented in 20 patients (35%). Thirteen patients with hilar obstruction and two patients with common duct obstruction required at least one reintervention; stent patency was restored in all patients but one. The overall 6-month survival rate was 50%, and the 12-month survival rate, 36%; no significant difference was found between patients with hilar and non-hilar obstruction. CONCLUSION: The long-term patency of the Wallstent endoprosthesis was excellent if common duct obstruction was treated but was significantly lower in the presence of hilar involvement. Use of the Wallstent did not result in a lower complication rate compared with the reported results of plastic endoprostheses. Reinterventions to restore stent patency were successful in almost all cases. The survival of patients with hilar and with non-hilar obstruction was similar.

Adult↗
PubMed1994

Choledochocele with obstructive jaundice: a case report and a review of the Japanese literature.

A case of a 57-year-old farmer with a rare type of choledochal cyst (choledochocele; Alonso-Lej's type III) is described. The patient was admitted because of obstructive jaundice and acute biliary infection. Abdominal computed tomography scan showed a cystic lesion in the head of the pancreas, and endoscopic retrograde cholangiopancreatography disclosed cystic dilatation of the terminal portion of the common bile duct. It was suspected that the choledochocele could swell and compress the common bile duct, causing obstructive jaundice and acute cholangitis; therefore, it was surgically resected. We also reviewed 61 cases of choledochocele reported in Japan; the findings were similar to those reported in the English literature.

Acute Disease↗
PubMed2003

Schwannoma of the common bile duct: a rare cause of obstructive jaundice.

The endoscopic diagnosis of bile duct lesions has improved over recent years through the introduction of cholangioscopy and intraductal ultrasound. Combining this with biopsies examined using routinely administered immunohistochemical markers, the diagnosis of tumors of the extrahepatic bile duct can be improved substantially. We report a rare case of a schwannoma of the bile duct causing obstructive jaundice.

Adult↗
PubMedDate not supplied

Collagen IV is a predictor for clinical course in patients with malignant obstructive jaundice.

BACKGROUND/AIMS: Increases in the serum extracellular matrix proteins (ECMPs) have been described in studies on cholestasis, therefore we investigated the serum levels of collagen IV, aminoterminal propeptide of type III procollagen, and hyaluronic acid prior to percutaneous transhepatic biliary drainage (PTBD) to evaluate its potential as a predictor for prolonged bilirubin clearance and clinical course in patients with malignant obstructive jaundice (MOJ). METHODOLOGY: Serum levels of ECMPs were prospectively investigated in 42 patients with MOJ prior to PTBD. The study group was subdivided according to the bilirubin clearance, and was also subdivided according to the determined level of collagen IV (cut-off point of 260 ng/mL). RESULTS: Serum collagen IV was identified as an independent risk factor for prolonged bilirubin clearance (P=0.006). Receiver-operating-characteristic curve analysis revealed that serum collagen IV had a diagnostic accuracy of 79% at the cut-off point of 260 ng/mL. Furthermore, these results indicated that the level of collagen IV is a reliable marker of postoperative liver failure (P=0.029) and predictor of death from liver failure (P=0.02). CONCLUSIONS: Elevated serum collagen IV is a feature of MOJ commonly associated with prolonged bilirubin clearance, and a useful indicator of clinical course, postoperative morbidity, and mortality in patients with MOJ.

Aged↗
PubMed2003

Severe obstructive jaundice in a 90-year-old man caused by an annular pancreas. Report of a case.

Although the annular pancreas is a rare congenital malformation of the pancreatic glandular parenchyma, this pathology often remains asymptomatic until the adult or old age and can represent an incidental finding during an ERCP or an abdominal Computed Tomography, because the clinical appearance of this condition can be of very various kinds. We present a case of an extra-hepatic jaundice in a 90-year-old man, caused by an annular pancreas constricting coledochus. Description of this case results very interesting and particular for two reasons: the very old age of the patient, probably the oldest recorded, and the unusual clinical appearance: obstructive jaundice as beginning one symptom of this malformation.

Aged↗
PubMed2005

Pancreatic pseudoaneurysm of the superior mesenteric artery complicated with obstructive jaundice. A case report.

CONTEXT: Pancreatic pseudoaneurysm rupture is a rare complication of chronic pancreatitis, with severe prognosis and high mortality. Angiography is usually required for confirmation of the diagnosis, but transabdominal ultrasound and CT angiography are useful noninvasive diagnostic methods. CASE REPORT: We present the case of a 66-year-old patient with a large pancreatic pseudoaneurysm of the superior mesenteric artery complicated with obstructive jaundice. Transabdominal ultrasound with color and power Doppler showed a large pancreatic head pseudoaneurysm that communicated directly to the superior mesenteric artery. Presence of a spinning blood flow inside the pseudoaneurysm was visualized by color Doppler, with evidence of bidirectional flow in the pseudoaneurysm neck that was showed by Doppler spectral analysis. The contrast-enhanced helical computer tomography with multiplanar sagittal and the 3D reconstruction of coronal images confirmed the communication of the pseudoaneurysm with the superior mesenteric artery. The patient was scheduled for selective angiography and embolization. However, clinical evolution was rapidly deteriorating, with collapse, hemorrhagic shock and massive hemorrhage. The patient was operated on and subsequently died despite three days of intensive care, due to disseminated intravascular coagulation and multiorgan failure. CONCLUSION: Non invasive imaging methods consisting of transabdominal ultrasound with color Doppler and contrast-enhanced computer tomography with sagittal reconstruction of coronal images were very useful in the establishment of the diagnosis of pancreatic pseudoaneurysm of the superior mesenteric artery complicated with cholestatic jaundice. However, these imaging methods do not obviate the need for diagnostic and therapeutic angiography, eventually followed by surgical intervention in cases of recurrent bleeding or hemodynamic unstable patients.

Aged↗