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Results for “Jaundice, Obstructive”

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PubMed1989

Endoscopic palliation of malignant obstructive jaundice.

Patients referred for endoscopic retrograde cholangiopancreatography (ERCP) over a 12 month period who had a diagnosis of malignant obstructive jaundice prior to or confirmed by the procedure were reviewed. Insertion of a biliary endoprosthesis was attempted in 23 out of 26 patients and was successful in 19 (82%). A significant fall in bilirubin was seen in 15 (79%) of those who had a successful procedure. The only early complication was cholangitis in two patients. Late complications were related to occlusion of the endoprosthesis and replacement was required in six patients. Endoscopic palliation of malignant obstructive jaundice is a useful technique and should be considered as the initial procedure in all patients considered to have nonresectable malignancy.

Adult↗

PubMed1995

Successful management of infantile hepatic hilar hemangioendothelioma with obstructive jaundice and consumption coagulopathy.

A 4-month-old boy with benign hemangioma of the porta hepatis is described. Obstructive jaundice and consumption coagulopathy developed, which were treated by percutaneous transhepatic drainage (PTHD), without resection of the tumor or bypass surgery. Because of tumor regression, the patient has remained free of symptoms even after the PTHD tube was removed. Because juvenile hemangioma is a benign tumor and occasional spontaneous regression is known to occur (as in our case and other reports), it is suggested that complete resection or bypass surgery is not necessary for juvenile hemangioendothelioma, even with obstructive jaundice, if bile drainage is adequately maintained.

Cholestasis↗

PubMed1977

Obstructive jaundice secondary to hepatoma. Case report and literature review.

A 67-year old male, who presented a clinical picture of obstructive jaundice with cholangitis, was found to have hepatoma tumor embolus blocking the common duct. The site of invasion was the right hepatic duct. There are 15 such cases reported in the literature. Hepatoma rarely presents with obstructive jaundice. A clinical picture of biliary colic or cholangitis is frequently misleading. Invasion of a hepatic duct large enough to allow formation of a tumor embolus implies tumor close to the bifurcation of right and left hepatic ducts and has precluded effective surgical treatment in all but one case.

Aged↗

PubMed2000

Biliary indocyanine green excretion as a predictor of hepatic adenosine triphosphate levels in patients with obstructive jaundice.

BACKGROUND: Correlation of the hepatic adenosine triphosphate (ATP) level with indocyanine green (ICG) excretion into bile was examined in patients with obstructive jaundice after the relief of hyperbilirubinemia by preoperative percutaneous transhepatic biliary drainage (PTBD). METHODS: Patients with complete bile duct obstruction, the mean serum total bilirubin concentration being 13.6 +/- 8.5 (SD) mg/dL, underwent PTBD prior to surgery. Within a few days before surgery when the mean serum total bilirubin level decreased to 1.2 mg/dL, ICG (0.5 mg/kg) was intravenously injected, and the whole bile was collected at 1-hour intervals for 5 hours. The ICG concentration in bile, bile flow rate, amount of ICG excreted in bile, and biliary ICG excretion rate as percentage of the injected dose were determined. At the time of surgery, a small liver tissue sample was obtained immediately after laparotomy without any ischemic procedures, and ATP concentrations were determined. Results of hepatic ATP levels were correlated with laboratory and clinical determinations. RESULTS: The bile flow rate was essentially constant during the 5-hour period, the mean value being 21 mL/hour. The ICG concentrations in bile gradually increased, reached the maximal level in 3 hour, and declined thereafter. The biliary ICG excretion rate for 5 hours was 40% +/- 18% of its injected dose. The biliary ICG excretion rate and amount of ICG excreted in bile for 5 hours significantly (P <0.05) correlated with the hepatic ATP level. The decline index of serum bilirubin during PTBD was also correlated with the hepatic ATP level. The serum ICG retention rate, bile flow rate, maximal ICG concentration in bile, and other liver function tests including serum albumin and cholinesterase levels did not correlate with the hepatic ATP level. CONCLUSIONS: Both the amount of and excretion rate of ICG in bile reflect the hepatic ATP level. Determination of biliary ICG excretion contributes to precise evaluation of hepatic energy status before surgery in patients with obstructive jaundice.

Adenosine Triphosphate↗

PubMed1999

Tuberculosis of the bile duct: a rare cause of obstructive jaundice.

Tuberculosis of the bile duct is extremely rare. Patients with this condition usually present with a protracted illness and obstructive jaundice, which may be confused with hepatobiliary malignancies. A retrospective review of hospital records of patients who presented with tuberculosis of the bile duct between January 1986 and December 1996 was undertaken, and data were obtained concerning clinical presentation, investigations, treatment, and follow-up. Four patients (one man and three women) with a mean age of 44.8 years had tuberculosis of the bile duct. Diagnostic imaging techniques showed bile duct dilation in all four patients. Endoscopic retrograde cholangiopancreatography (ERCP) showed a stricture in the proximal common bile duct (CBD) in one patient, a stricture in the distal CBD in one patient, a stricture in the common hepatic duct (CHD) in one patient, and multiple strictures in the CHD and left intrahepatic duct in one patient. Bile cytology and fine-needle aspiration identified correctly the diagnosis in each patient. Two patients underwent laparotomy with the initial suspicion of cholangiocarcinoma; the correct diagnosis was made based on frozen sections taken intraoperatively. One patient was treated with endoscopic stenting and three patients underwent laparotomy for bile duct obstruction. All patients received antituberculous therapy. There were no deaths; all patients remained healthy at a mean follow-up of 36.5 months. It is important to obtain a tissue diagnosis in all patients with obstructive jaundice to avoid missing this rare but curable disease. The treatment of tuberculosis of the bile duct involves relief of the bile duct obstruction and antituberculous therapy.

Adult↗

PubMed1991

Growth failure and decreased levels of insulin-like growth factor I in obstructive jaundice are reversed by bile diversion.

Insulin-like growth factor I (IGF-I) is one of the principal stimuli of linear growth. Growth failure in children with chronic cholestatic jaundice may be related to decreased hepatic synthesis of IGF-I. It was hypothesized that (1) biliary obstruction would lead to growth retardation and decreased circulating IGF-I levels; and (2) surgical drainage of the obstructed biliary system would reverse these effects. To test this hypothesis, the following study of male Sprague-Dawley rats (135 g; 10 animals per group) was performed. Group I underwent common bile duct ligation (CDL); group II underwent choledochoduodenostomy 2 weeks following CDL; group III were sham-operated and fed with CDL rats; and group IV were sham-operated and fed ad libitum. Daily food intake and weekly body weight were recorded. Statistical analysis was by repeated-measures analysis of variance and individual comparisons were evaluated by Student's t test. Biliary obstruction results in decreased food intake, rate of weight gain, and IGF-I levels. A significant reduction in IGF-I levels was also noted in the pair-fed sham-operated rats (group III). Relief of obstructive jaundice by surgical drainage results in a reversal of these changes. It is concluded that the growth failure and decreased IGF-I levels associated with obstructive jaundice can be reversed by surgical drainage of the obstructed biliary system and, in part, are due to inadequate nutrition.

Analysis of Variance↗

PubMed1996

Effects of obstructive jaundice and external biliary diversion on bacterial translocation in rats.

OBJECTIVE: To find out the rate of translocation of bacteria to visceral organs in obstructive jaundice, and whether the absence of bile within the intestine or the presence of obstructive jaundice itself promotes bacterial translocation. DESIGN: Prospective, controlled experimental animal study. SETTING: University hospital, Turkey. SUBJECTS: 40 Inbred albino rats weighing 160-220 g. INTERVENTIONS: Three groups of rats were studied: sham operated controls (n = 15), ligation of the common bile duct (CBD) (n = 15), and CBD-ligation and proximal external biliary division through a Silastic catheter (n = 10). Specimens of distal small bowel mesenteric lymph nodes (MLN), liver, spleen, and lung were obtained on the 10th postoperative day, and quantitative bacteriological analysis done. Caecal aerobic microflora were also measured for qualitative and quantitative comparisons. RESULTS: The translocation of bacteria to MLN, liver, and spleen, but not to the lungs, was slightly but not significantly increased by ligation of the CBD. Ligation of the CBD with simultaneous external biliary diversion caused increase translocation to all organs examined (with the increases to the MLN (p = 0.012), liver (p = 0.009), and spleen (p = 0.028) being significant). There was no difference in the raised bacterial counts in MLN and visceral organs after ligation of the CBD or biliary diversion. The pattern of caecal microflora did not change in any group. CONCLUSIONS: These findings suggest that the absence of bile from the gut may promote bacterial translocation to visceral organs.

Animals↗

PubMed1999

Cytokine release during hypoxia reoxygenation by Kupffer cells in rats with obstructive jaundice.

The release of cytokine by Kupffer cells during hypoxia/reoxygenation was studied in vitro in male Wistar rats with obstructive jaundice to investigate the kinetics of interleukin-8 (IL-8) release by Kupffer cells during hypoxia/reoxygenation, and to study the influence of endotoxin during the reoxygenation period. The rats were divided into two groups: one that underwent bile duct ligation (group OJ), and one that underwent a sham operation (group C). Kupffer cells were isolated by collagenase digestion and centrifugal elutriation. The cells were first subjected to hypoxia as 95% nitrogen, after which they were given reoxygenation as 95% oxygen. In addition, they were stimulated with lipopolysaccharide (LPS) 0, 1, and 10 ng/ml. In both groups, the levels of IL-8 became increased during the period of hypoxia/reoxygenation, and reoxygenation after hypoxia further intensified IL-8 production. During the period of hypoxia, the IL-8 levels in group OJ were significantly increased compared with those in group C. With the LPS challenge, there was no significant difference in IL-8 levels in either group. In conclusion, obstructive jaundice induces the activation of Kupffer cells, resulting in increased IL-8 production during hypoxia/reoxygenation.

Analysis of Variance↗

PubMed2005

Herniation through the foramen of Winslow presenting as obstructive jaundice.

Herniation through the foramen of Winslow is a rare variety of paraduodenal hernia. We report a 19-month-old child with obstructive jaundice due to midgut herniation through the foramen of Winslow with associated volvulus. The herniation and volvulus were precipitated by intestinal malrotation. The patient underwent extraamniotic silo repair of exomphalos major in the neonatal period. Investigation for malrotation is recommended after extraamniotic closure of exomphalos.

Female↗

PubMedDate not supplied

A case of biliary cystadenoma with obstructive jaundice.

Biliary cystadenoma is a rare cause of obstructive jaundice. We report a case of a 78-year-old Japanese man with biliary cystadenoma presenting repetitive abdominal pain and jaundice. Ultrasound sonography revealed a hyperechoic mass in the left lateral lobe of the liver. Histological examination revealed a biliary cystadenoma. Intracystic hemorrhage was assumed to be the cause of obstruction of the bile ducts.

Adenoma, Bile Duct↗

PubMed1970

A lipoprotein characterizing obstructive jaundice. II. Isolation and partial characterization of the protein moieties of low density lipoproteins.

The plasma low density lipoproteins (LDL) in biliary obstruction are characterized almost exclusively by the presence of the immunochemically distinct lipoprotein families, lipoprotein B (LP-B) and lipoprotein X (LP-X). It is suggested that LP-X, with its uniquely high content of unesterified cholesterol and phospholipid, is primarily responsible for the unusual lipid composition of LDL and the abnormal plasma lipid composition in obstructive jaundice. To show their protein moieties, we isolated LP-X and LP-B from the LDL in plasma obtained from patients with obstructive jaundice. A separation procedure was employed which combines ultracentrifugation, heparin precipitation, and ethanol fractionation. Whereas LP-B was characterized by the presence of apolipoprotein B (ApoB), intact LP-X contained a protein moiety of unique composition consisting of a mixture of albumin (approximately 40%) and the specific apolipoprotein, ApoX (60%). These two protein moieties were separated by preparative ultracentrifugation at d 1.21 g/ml of a solution of partially delipidized LP-X. LP-X thus comprises an albumin-lipoprotein complex in which the masked antigenic site of albumin can be revealed by partial or total delipidization. Apolipoprotein X, the characteristic nonalbumin protein moiety of intact or partially delipidized LP-X, was immunochemically different from ApoA, ApoB, albumin, gamma-globulins, and other serum proteins. The results of analytical ultracentrifugation and the immunochemical and electrophoretic properties of ApoX indicated it to be a complex protein consisting possibly of several nonidentical polypeptides. ApoX was characterized by its amino acid composition, and by serine and threonine as the major N-terminal and alanine as the major C-terminal amino acids. It has been suggested that ApoX is similar to, if not identical with, apolipoprotein C.

Alanine↗

PubMed1984

[Effect of obstructive jaundice on acute gastric ulceration viewed from gastric mucosal energy metabolism in rats].

The mechanism of acute gastric ulceration in rats with obstructive jaundice was investigated in terms of the changes in the gastric mucosal energy metabolism. Rats were divided into 4 groups as follows: control, vagotomized, jaundiced, and jaundiced and vagotomized group. The water immersion and restraint procedures were performed and the ulcer index was calculated. The change of energy metabolism in the gastric mucosa of corpus and antrum was clarified by measuring ATP and energy charge. The following results were obtained: Vagotomized group showed significant decreased ulcer index, however, the gastric mucosal energy metabolism were unchanged compared to the control group after stress. Jaundiced group showed significant higher ulcer index, and the early, significant depression of the gastric mucosal energy metabolism compared to the control group. Jaundiced and vagotomized group showed significant improvement of ulcer index and gastric mucosal energy metabolism compared to the jaundiced group. The gastric energy metabolism of the corpus revealed more prominent depression than that of the antrum in jaundiced group, and jaundiced and vagotomized group. These data suggested that the deterioration of the gastric mucosal energy metabolism after stress was enhanced under the condition of obstructive jaundice and these results were improved by vagotomy.

Acute Disease↗

PubMed1999

Obstructive jaundice caused by a huge liver cyst riding on the hilum: report of a case.

A 71-year-old man presented to our hospital with obstructive jaundice, found to be caused by a huge liver cyst which was centrally located and riding on the hilum. Percutaneous transhepatic cyst drainage was performed, following which obstruction of the bile duct was relieved and the jaundice subsided. As jaundice recurred after removal of the drainage tube, the patient underwent deroofing, since when he has remained well. Only 13 cases of liver cysts producing obstructive jaundice have been reported in the English literature, most of which were characteristically enormous, located centrally, and riding on the hilum. Liver cysts possessing such features are likely to cause obstructive jaundice by compressing the hepatic hilum. Cyst drainage is helpful for ameliorating the jaundice and making an accurate diagnosis; however, subsequent deroofing or injection therapy is necessary to prevent recurrence.

Aged↗

PubMed1984

Ultrasonography in the diagnosis of obstructive jaundice.

Ultrasonography was employed in the diagnosis of obstructive jaundice. In a group of 38 patients who were studied, Ultrasonography was found to be reliable in confirming the diagnosis. In majority of the cases it was also found to be reliable in revealing the cause of obstruction. Nineteen of these patients were examined by percutaneous transhepatic cholangiography (PTC) and there were 100 per cent correlation with Ultrasonography. Twelve of these patients underwent operation and the findings were in good agreement with those of Ultrasonography.

Cholestasis↗

PubMed2002

[Role of interventional radiography in the treatment of the hepato-pancreato-duodenal area, complicated by obstructive jaundice].

We assessed the role of interventional radiological procedures used in the treatment of patients with hepatopancreatobiliary cancer complicated by obstructive jaundice. Between 1990 and 2000, 71 patients underwent percutaneous transhepatic biliary drainage (PTBD): external drainage--18 (group A); external-internal drainage or stenting (group B), and external-internal drainage or stenting plus chemoinfusion or chemoembolization of the hepatic artery--15 (group C). Mean survival (M(SD) calculated for patients who died was 2.1(0.5 mo for group A; (pb,c(0.01), 7.9(6.7 mo (group B), and 16.6(14.8 mo for group C (NS with B). The actual one-year survival was 10, 25, and 45%, respectively. External-internal PTBD and stenting are safe effective palliative procedures for patients with malignant obstructive jaundice. Survival in patients with hepatopancreatobiliary cancer doubled after chemoinfusion or chemoembolization, without grave complications or lethality.

Adult↗

PubMed1996

Portal vein thrombosis mimicking tumour and causing obstructive jaundice. A case report.

The case of a 28-year-old female patient with portal vein thrombosis mimicking tumour and causing obstructive jaundice is presented. The cavernous-transformed enlarged portal vein, explaining the mass-like lesion in the hepatic hilum on ultrasonography, compressed the extrahepatic bile ducts and caused obstructive jaundice. Endoscopic retrograde cholangiography demonstrated multiple nodular extrinsic indentations of the extrahepatic bile ducts with moderately dilated intrahepatic bile ducts.

Adult↗

PubMed2005

[Post-cholecystectomy amputation neuroma of the common bile duct with obstructive jaundice].

Amputation neuroma of the common bile duct after surgery is a rare and mostly asymptomatic lesion. A 60-year old patient presented with obstructive jaundice three months after a cholecystectomy for symptomatic gallstones. Imaging investigations showed common extrahepatic bile duct stenosis. Surgical resection of the stricture with biliodigestive anastomosis was performed. Histological examination of the surgical specimen revealed an amputation neuroma. Despite its rarity, amputation neuroma of the common bile duct should be considered in patients with post-cholecystectomy syndrome following liver or extrahepatic bile duct surgical procedures.

Cholecystectomy↗

PubMed2004

[Obstructive jaundice after cholecystectomy].

In this article we present the case of a 72 year-old woman who three years after laparoscopic cholecystectomy develops obstructive jaundice. An MRI of the liver and biliary system revealed an hiliar mass that caused dilatation of the biliary tree. The patient underwent hepatic duct resection and reconstruction via hepaticojejunostomy. The histological examination of the surgical specimen identified an intramural biliary neuroma with no evidence of malignancy.

Aged↗