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

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.
Abnormalities ; Aged ; *Cysts/complications/diagnosis/pathology ; *Duodenal Diseases/complications/diagnosis/pathology ; Humans ; Jaundice, Obstructive/*etiology ; Male ; Pancreatitis/*etiology

PURPOSE: A preoperative biliary drainage procedure (endoscopic nasogastric biliary drainage, ENBD; endoscopic retrograde biliary drainage, ERBD; or percutaneous transhepatic biliary drainage, PTBD) is infrequently performed in periampullary cancer patients with obstructive jaundice. Among these different biliary drainage procedures, a safer and more informative procedure should be performed in the indicated cases. However, no comparative study has been done between the two biliary drainage methods (endoscopic vs. percutaneous). The aim of this study is to compare the clinical outcome of these two biliary drainage methods in periampullary cancer and to suggest guidelines for selecting the appropriate preoperative biliary drainage procedure. METHODS: Between January 1996 and June 2002, 25 patients underwent pancreaticoduodenectomy (Whipples' operation or pylorus preserving pancreaticoduodenectomy) after ENBD/ERBD (Group A) due to periampullary cancer. Twenty- five patients who ubderwent PTBD preoperatively were matched with Group A, according to age group, sex, diagnosis, and type of operation during the same period (Group B). RESULTS: There were no differences in operative time, intraoperative/postoperative transfusion, total/postoperative length of hospital stay, incidence of postoperative complication, TNM staging, or perineural/endovascular/endolymphatic invasion. However, the thickness of CBD wall (Group A: Group B=1.78+/-0.55 mm : 1.14+/-0.37 mm, P<0.001) and degree of inflammation of the CBD wall (Group A> Group B, P<0.001) were significantly different between the two groups. CONCLUSION: Although a significant difference of clinical outcome between the two preoperative biliary drainage methods could not be identified in this study, the inflammation of operative field resulting from ENBD/ERBD is expected to cause surgical difficulties and ultimately affect postoperative complications.
Diagnosis ; Drainage* ; Humans ; Incidence ; Inflammation ; Jaundice, Obstructive ; Length of Stay ; Neoplasm Staging ; Operative Time ; Pancreaticoduodenectomy ; Postoperative Complications ; Pylorus

To study the manifestations of endoscopic retrograde cholangiopancreatography (ERCP) in patients of obstructive jaundice associated with HCC, 32 cases of histopathologically diagnosed HCC with obstructive jaundice were successfully examined with routine ERCP. 31 patients were demonstrated by ERCP as having malignant obstructive jaundice. Among them, 19 were hepatic perihilar bile duct stricture, 7 bile ductile tumorous thrombus, 3 perihilar bile duct stricture complicated with thrombus, 2 metastasis to hilar lymph node, and 1 common bile duct stone as proven by sphincterotomy. The malignant perihilar stricture was all of type III and IV by Bismuth standard of Klastin tumor. In patients identified as having bile duct tumor thrombus, by the Ueda classification, none was of type I and II; 1 type III a; 4 III b; 2 type IV. HCC with obstructive jaundice was mainly caused by the malignant infiltration of tumor, and most stricture was of serious nature. When major extra-hepatic bile duct was involved by tumor thrombus, obstructive jaundice might develop. Malignant perihilar stricture and tumor thrombus might coexist in some patients. Jaundice was rarely caused by hepatic hilar lymph node metastasis. Jaundice was not necessarily caused by tumors and sometimes, it might be caused by common bile stones. Care should be exercised in differentiation diagnosis in such patients.
Adult ; Aged ; Carcinoma, Hepatocellular ; complications ; diagnosis ; pathology ; Cholangiopancreatography, Endoscopic Retrograde ; Female ; Humans ; Jaundice, Obstructive ; diagnosis ; etiology ; Liver Neoplasms ; complications ; diagnosis ; pathology ; Male ; Middle Aged

No abstract available.
Child, Preschool ; Cholestasis/diagnosis/etiology ; Drainage ; Female ; Fibrosis ; Humans ; Jaundice, Obstructive/*diagnosis/etiology ; Pancreatitis/complications/*diagnosis/pathology ; Tomography, X-Ray Computed

Echinococcal disease can develop anywhere in the human body. The liver represents its most frequent location. Hepatic hydatid cysts may rupture into the biliary tract, thorax, peritoneum, viscera, digestive tract or skin. We report a rare case with rupture of the right hepatic duct into a hydatid cyst in a woman with known hydatid disease and choledocholithiasis. The increased intra-luminal pressure in the biliary tree caused the rupture into the adjacent hydatid cyst. The creation of the fistula between the right hepatic duct and the hydatid cyst decompressed the biliary tree, decreased the bilirubin levels and offered a temporary resolution of the obstructive jaundice. Rupture of a hydatid cyst into the biliary tree usually leads to biliary colic, cholangitis and jaundice. However, in case of obstructive jaundice due to choledocholithiasis, it is possible that the cyst may rupture by other way around while offering the patient a temporary relief from his symptoms.
Bilirubin/blood ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy ; Choledocholithiasis/complications/diagnosis ; Common Bile Duct/surgery ; Echinococcosis, Hepatic/complications/*diagnosis/surgery ; Female ; Gallstones/complications/diagnosis ; Hepatic Duct, Common/*surgery ; Humans ; Jaundice, Obstructive/complications/diagnosis ; Middle Aged ; Rupture ; Tomography, X-Ray Computed

Primary non-Hodgkin's lymphoma arising from the bile duct is extremely rare and the reported imaging features do not differ from those of cholangiocarcinoma of the bile duct. We report a case of a patient with extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue (MALT), who presented with obstructive jaundice and describe the distinctive radiologic features that may suggest the correct preoperative diagnosis of primary lymphoma of the bile duct. Primary MALT lymphoma of the extrahepatic bile duct should be considered in the differential diagnosis when there is a mismatch in imaging findings on computed tomography or magnetic resonance imaging and cholangiography.
Bile Duct Neoplasms/complications/*diagnosis/radiography ; *Bile Ducts, Extrahepatic ; Cholangiocarcinoma/diagnosis ; Cholangiography ; Diagnosis, Differential ; Humans ; Jaundice, Obstructive/complications/diagnosis ; Lymphoma, B-Cell, Marginal Zone/complications/*diagnosis/radiography ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Tomography, X-Ray Computed

Biliary complication occurs in 6-34% of all liver transplant patients. Although bile leaks and strictures are relatively common, other biliary complications such as T-tube leak, choledocholithiasis, and biliary cast syndrome can also be observed. The biliary cast syndrome describes the presence of casts causing obstruction with its resultant sequelae of biliary infection, hepatocyte damage secondary to bile stasis and ductal damage, all contributing to cholangiopathy. Because the exact timing of cast formation after orthotopic liver transplantation is not consistent, it is difficult to define the true incidence of biliary cast syndrome without long-term follow-up data. Proposed etiological mechanisms include acute cellular rejection, prolongation of cold ischemic time, infection, biliary drainage tubes, and biliary obstruction. The diagnosis of biliary cast syndrome is usually confirmed by endoscopic retrograde cholangiopancreatography. There have been few published articles about biliary casts in Korea. Herein, we report a case of biliary cast syndrome followed by orthotopic liver transplantation.
Adult ; Bile Duct Diseases/*complications/diagnosis/etiology ; Female ; Humans ; Jaundice, Obstructive/*etiology ; Liver Transplantation/*adverse effects ; Male ; Middle Aged ; Retrospective Studies ; Syndrome

Biopsy ; methods ; Drainage ; Humans ; Jaundice, Obstructive ; etiology ; therapy ; Lymph Node Excision ; methods ; Neoplasm Staging ; Pancreatic Neoplasms ; complications ; diagnosis ; pathology ; surgery ; Pancreaticoduodenectomy ; methods ; Salvage Therapy