PubMed · 6567160
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P Datta. 1984-09-19. Diagnosing obstructive jaundice.. https://pubmed.ncbi.nlm.nih.gov/6567160/
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The decision to perform surgical versus nonoperative palliation for unresectable pancreatic cancer is influenced by a number of factors. In most cases, patient symptoms clearly dictate the management. In patients with symptoms of duodenal obstruction at the time of presentation, surgery is the only option. In patients with obstructive jaundice alone, the options for management must be weighed against factors such as overall health status, projected survival, and procedure-related morbidity and mortality. A prospective multicenter trial recently analyzed factors influencing perioperative morbidity and mortality following both curative and palliative surgery for pancreatic cancer. This analysis demonstrated that preoperative diabetes, low Kanofsky's index, and liver metastases are significant risk factors in predicting perioperative morbidity and mortality in patients undergoing palliative procedures for pancreatic cancer. Another analysis focusing on tumor characteristics suggested that for patients with Stage I and Stage II disease (i.e., with no evidence of systemic metastases), survival and the potential for late duodenal obstruction favor surgical management. In summary, although patient management must be individualized, most patients with pancreatic cancer in good medical health and with no evidence of systemic disease are most appropriately managed with surgical palliation. This option affords patients the best chance of avoiding the late complications of recurrent jaundice, duodenal obstruction, and disabling pain. Surgical palliation can generally be completed with an acceptable perioperative morbidity and mortality and a hospital stay of approximately 2 weeks. Finally, only surgical exploration can offer full opportunity for resection for cure.
Primary endocrine neoplasms of intra- and extrahepatic biliary ducts are very rare. We describe the first case of a primary endocrine tumor of the common bile duct producing gastrin. A 53-year-old woman had a 3-year history of recurrent duodenal and gastric ulcers as well as obstructive jaundice. A small neoplasm was found in the lower third of the common bile duct, which showed diffuse gastrin production and focal synthesis of serotonin and pancreatic polypeptide by immunohistochemistry and electron microscopy. Although serum gastrin was within normal levels (90 ng/ml), symptoms of peptic acid disease could have been related to hypergastrinemia, since gastric and duodenal ulcers healed after surgical removal of the tumor. She has remained asymptomatic for 8 months.
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