The most causes of an icteric hepatoma are a late stage hepatocellular carcinoma or intrahepatic cholangiocarcinoma. A hepatocellular carcinoma, causing an obstrucution of the bile duct, rarely results in jaundice. With a late stage hepatocellular carcinoma, the accurate diagnosis and treatment may be difficult. Herein, we report a case of a hepatocellular carcinoma and obstructive jaundice, due to hilar tumor emboli, with a review of the literature.
Bile Ducts ; Carcinoma, Hepatocellular* ; Cholangiocarcinoma ; Diagnosis ; Jaundice* ; Jaundice, Obstructive

Computed tomographic (CT) scans of 46 jaundiced patients were studied to determine the value of CT in the diagnosis of biliary pathology. AII ofthe 12 cases of medical jaundice had positive CT correlation. Of the 34 cases of proven surgical jaundice, 97 .8% were correctly identified by CT. In detecting the level of obstruction, the cases were divided into four groups by anatomica l segments, according to the number of visualized low density ringlike structures produced by dilated bile duct. All of the correctly diagnosed surgical jaundice was 91.2%. The presence of stones or mass, the level of obstruction and the relative size and shape of visualized distal ring had proved to be the most important variables in etiological diagnosis of surgical jaundice. The results indicate that CT is useful and highly accurate in differenting between surgical (obstructive) jaundice and medical (non-obstructive) ajundice, and determining the level of obstruction and the etiology of surgical jaundice.
Bile Ducts ; Diagnosis ; Humans ; Jaundice ; Jaundice, Obstructive ; Pathology

The value of ultrasonography and percutaneous transhepatic cholangiography in determining the site and etiology of biliary obstruction with surgical jaundice was studied in 30 patients. All diagnoses were subsequently made by surgery and pathology. The results were as follows; 1. In ultrasonography, the site of obstruction was delineated in 46%, while the etiology of the lesion was established in 40%, In comparison, percutaneous transhepatic cholangiography delineated the site in 100% and the etilogy in 93%. 2. Although the percutaneous transhepatic cholangiography is invasive to the human body, it is considered to be the single procedure of choicein the managment of the patient with biliary obstructive jaundice because of its diagnostic accuracy, technical simplicity and relative safety.
Cholangiography ; Diagnosis ; Human Body ; Humans ; Jaundice ; Jaundice, Obstructive ; Pathology ; Ultrasonography

Although pulmonary tuberculosis is known to be the most common type in tuberculosis, it actually can affect any organ system. However, abdominal type is very rare among the extra-pulmonary types, and obstructive jaundice caused by lymphadenopathies due to tuberculosis is especially uncommon manifestation even in endemic areas. Tuberculous lymphadenopathies can mimic lymphadenopathies by other metastatic tumors or lymphoma, thus early correct diagnosis is very important for avoiding unnecessary surgical interventions. Here, we reported two cases of obstructive jaundice caused by tuberculous lymphadenopathies. Both were treated with anti-tuberculosis medications and endoscopic retrograde biliary drainage without surgery.
Diagnosis ; Drainage ; Jaundice ; Jaundice, Obstructive* ; Lymphatic Diseases ; Lymphoma ; Tuberculosis ; Tuberculosis, Pulmonary

In 101 jaundiced patients, gray scale ultrasonography of longitudinal scan in RAO position demonstrated themeasurable extrahepatic biliary system in 73 patient; 17 cases (50%) of those with nonobstructive jaundice and 56cases (84%) of those with obstructive jaundice. The size of the internal diameter of extrahepatic biliary systemindicated that obstructive jaundice was best differentiated from non-obstructive jaundice when diameter above 7mm served as abnormal extrahepatic duct in jaundiced patients, giving sensitivity 85.5% specificity 97% anddiagnostic accuracy 89.5% by decision matrix analysis. The overall etiological diagnostic accuracy in obstructivejaundice was 40% which had higher one in choledocholithiasis and pancreas head carcinoma than other diseases. Thesonography should be imaging procedure of choice in differential diagnosis of jaundiced patients, which is simple, safe, noninvasive and has high diagnostic accuracy in differentiation between the two.
Bile Ducts, Extrahepatic ; Choledocholithiasis ; Diagnosis, Differential ; Head ; Humans ; Jaundice ; Jaundice, Obstructive ; Pancreas ; Sensitivity and Specificity ; Ultrasonography

Biliary atresia (BA) is very difficult to distinguish from neonatal hepatitis (NH) and its prognosis depends on the age at the time of Kasai operation. Therefore early differentiation between these two conditions is very important. Although various clinical and laboratory tests have been reported to differentiate between them, they are still of limited value. From 1980 to 1999, forty-five infants were referred to our pediatric surgical unit for operation for suspected BA. Eight patients underwent Kasai operation immediately because late diagnosis. These were excluded from the study. The clinical history, physical findings, radiologic and laboratory examinations of 37 cases were analyzed retrospectively. The average age of BA (n=20) was 55.1+/-6.7 days, and that of NH (n=17) was 55.8+/-5.6 days. The sex ratio of BA was 13:7, and that of NH was 14:3. All the patients had obstructive jaundice and acholic stool except 4 BA and 6 NH patients. Acholic stool with yellow component was more frequent in NH. Onset of jaundice was within 2 weeks after birth in 85% of BA, and in 65% of NH. The onset of acholic stool was within 2 weeks after birth in 60% of BA, and in 23.5% of NH. The duration of jaundice and acholic stool of BA were 50.9+/-6.6 days and 41.3+/-8.4 days and those of NH were 40.1+/-3.1 days and 26.6+/-5.4 days respectively. The ultrasonogram and hepatobiliary scan were useful, but not a definitively reliable method for the differentiation of these two diseases. There was no difference in laboratory data. Seventeen cases had NH among 45 referred cases for Kasai operation with the clinical impression of BA, and 4 cases of 17 NH cases needed to be explored to rule out BA. In conclusion, false positive rate of clinical impression of BA was 37.8%, and negative exploration rate was 8.9%. Therefore, careful clinical observation for 1-2 weeks by an experienced pediatric surgeon was very important to avoid unnecessary operation to rule out NH up to the age of 8 - 10 weeks, so long as the stool had yellow component.
Biliary Atresia* ; Delayed Diagnosis ; Diagnosis, Differential ; Hepatitis ; Humans ; Infant ; Jaundice ; Jaundice, Obstructive ; Parturition ; Prognosis ; Retrospective Studies ; Sex Ratio ; Ultrasonography

Cholestasis ; diagnosis ; Chronic Disease ; Diagnosis, Differential ; Humans ; Infant ; Jaundice, Obstructive ; diagnosis ; Male

No abstract available.
Aged, 80 and over ; Cholecystitis/*complications/diagnosis ; Hemobilia/diagnosis/*etiology ; Humans ; Jaundice, Obstructive/etiology ; Male

The authors experienced three cases of cholangiocarcinoma associated with profuse mucin production. We intended to review and summarize the clinical features of these patients to emphasize the clinical importance of mucin-producing cholangiocarcinoma. All patients were female. Symptoms were mainly right upper quadrant pain and jaundice. Diagnosis was made by characteristic endoscopic retrograde cholangiographic findings and computed tomography. Bile ducts were dilatated and obstructive jaundice had developed as a result of the accumulation of mucin realeased by the tumor. Treatments were hepatic lobectomies for two intrahepatic cholangiocarcinoma patients and extrahepatic bile duct resection and hepaticojejunostomy for one patient. There was no postoperative complication. Pathologies were well differentiated papillary adenocarcinoma in two cases. Two patients are still living without recurrence for over three and four years respectively. One patient who had T4 lesion died of recurrence 38 months after operation. Conclusively, aggressive surgical treatment may be justified in the treatment of mucin hypersecreting cholangiocarcinoma even in advanced stage in view of the favorable outcome after radical operation. Further study is needed to clarify its biological behavior.
Adenocarcinoma, Papillary ; Bile Ducts ; Bile Ducts, Extrahepatic ; Cholangiocarcinoma* ; Diagnosis ; Female ; Humans ; Jaundice ; Jaundice, Obstructive* ; Mucins ; Pathology ; Postoperative Complications ; Recurrence

The web of the common bile duct is an extremely rare anomaly and the cause of the obstructive jaundice. We experienced a case of the congenital web of common bile duct in a 42 years old male who complained of jaundice for 10 days prior to admission without choledocholithiasis and cholangitis. An endoscopic retrograde cholangiopancreatography revealed a common bile duct web (transverse, diaphragmatic type) and the diagnosis was confirmed by an endoscopic forcep biopsy. We reported a case of the congenita1 web of the common bile duct which was treated with a stent insertion and balloon dilatation.
Adult ; Biopsy ; Cholangiopancreatography, Endoscopic Retrograde ; Cholangitis ; Choledocholithiasis ; Common Bile Duct* ; Diagnosis ; Dilatation* ; Humans ; Jaundice ; Jaundice, Obstructive ; Male ; Stents ; Surgical Instruments