Obstructive jaundice in neonates

The causes of jaundice in the first few weeks of life may be categorised into hematologic, enzymatic/metabolic, infectious and obstructive. Obstructive jaundice results from an interruption in the drainage of bile in the biliary system. Surgical causes of jaundice in neonates are biliary atresia, inspissated bile syndrome, intrahepatic hypoplasia, choledochal cyst, Caroli's disease and spontaneous perforation of the bile duct. Pediatricians should be aware of the pernicious consequences of unresolved biliary obstruction and should thus refer neonates or infants with inexplicable jaundice for surgical exploration at an earlier age.

Ampullary cancer and preoperative jaundice: possible indication of the minimal surgery

BACKGROUND/AIMS

Obstructive jaundice is common symptom of carcinoma of the ampulla of Vater. In the present study we evaluated association between preoperative jaundice and prognosis and possible indication of the minimal surgery.

METHODOLOGY

Clinicopathological features of 50 patients who underwent curative resection were examined retrospectively and statistically analyzed.

RESULTS

Thirty-two of the 50 patients (64%) had preoperative jaundice, and these patients had poorer survival compared with these without jaundice (5 year survival 57.2% vs. 100%, p < 0.01). Preoperative jaundice, serum carbohydrate antigen 19-9 level, pancreatic invasion, lymphatic invasion, venous invasion, perineural invasion, duodenal invasion, margin status, lymph node metastasis, and T stage were shown to be significant prognostic factors. In the 18 patients without preoperative jaundice, lymphatic invasion was significantly related to lymph node metastasis. In addition, 12 of the 14 patients without jaundice and lymphatic invasion were diagnosed as T1N0 (stage IA) disease, and all the tumors were papillary or well-differentiated adenocarcinoma.

CONCLUSIONS

Preoperative jaundice may reflect advanced-stage in case of ampullary cancer. Radical surgery may not be necessary in patients without preoperative jaundice if the tumor is diagnosed as a papillary or well-differentiated adenocarcinoma without lymphatic invasion.

[Modern tendencies in surgical treatment of patients with obturation jaundice complicated by hepatic insufficiency]

The article is devoted to the problem of efficacy of the hepatic insufficiency (HI) prophylaxis and treatment methods in obturation jaundice. The role of energy-depending processes and the oxygen deficiency in tissues in the HI occurrence and progressing, the possibilities of medicinal correction of such disorders were studied up. The authors follow the concept of expediency of the oxygen-bearing preparations, which improve the erythrocytes function and oxygen delivery to the tissues in combination with miniinvasive decompression of bilioefferent ways, incorporation into the treatment complex of HI of mechanic genesis.

Preoperative biliary drainage in patients with obstructive jaundice: history and current status

RATIONALE

Preoperative biliary drainage (PBD) has been introduced to improve outcome after surgery in patients suffering from obstructive jaundice due to a potentially resectable proximal or distal bile duct/pancreatic head lesion. In experimental models, PBD is almost exclusively associated with beneficial results: improved liver function and nutritional status; reduction of systemic endotoxemia; cytokine release; and, as a result, an improved immune response. Mortality was significantly reduced in these animal models. Human studies show conflicting results.

FINDINGS

For distal obstruction, currently the "best-evidence" available clearly shows that routine PBD does not yield the appreciated improvement in postoperative morbidity and mortality in patients undergoing resection. Moreover, PBD harbors its own complications. However, most of the available data are outdated or suffer from methodological deficits.

CONCLUSION

The highest level of evidence for PBD to be performed in proximal obstruction, as well as over the preferred mode, is lacking but, nevertheless, assimilated in the treatment algorithm for many centers. Logistics and waiting lists, although sometimes inevitable, could be factors that might influence the decision to opt for PBD, as well as an extended diagnostic workup with laparoscopy (on indication) or scheduled preoperative chemotherapy.

Initial experience with the prototype forward-viewing echoendoscope for therapeutic interventions other than pancreatic pseudocyst drainage (with videos)

BACKGROUND

The current oblique-viewing echoendoscope can occasionally be limited in its ability to perform therapeutic interventions because of the acute angle at which endoscopic accessories passed via the biopsy channel make contact with the gut wall. In an effort to overcome this limitation, a prototype forward-viewing echoendoscope was developed and successfully tested for performing transgastric drainage of pancreatic pseudocysts.

OBJECTIVE

Evaluation of an initial experience with the prototype forward-viewing echoendoscope for performing interventions such as bile-duct drainage, pelvic-abscess drainage, and fiducial marker placement via the transduodenal and transrectal approaches.

DESIGN

A retrospective study.

SETTING

An academic tertiary-referral center.

PATIENTS

Three patients.

INTERVENTIONS

By using the prototype forward-viewing echoendoscope, transduodenal drainage of an obstructed bile duct, transrectal drainage of a pelvic abscess, and placement of fiducial markers in a rectal cancer were undertaken in 3 patients.

MAIN OUTCOME MEASUREMENTS

To evaluate the feasibility of performing interventions via the transduodenal and transrectal approaches by using the prototype forward-viewing echoendoscope.

OBSERVATIONS

The procedures were technically successful in all 3 patients, and no procedural complications were encountered. The passage of accessories and the deployment of stents were technically easy with the forward-viewing echoendoscope. In addition, there was no need to reorient the position of the echoendoscope when switching from a sonographic to endoscopic view while performing therapeutic interventions.

LIMITATION

Small number of patients.

CONCLUSIONS

It was feasible to perform interventions such as drainage of an obstructive bile duct and a pelvic abscess, and placement of fiducial markers via the transduodenal and transrectal approaches by using the prototype forward-viewing echoendoscope. Further studies that include larger numbers of patients are needed to evaluate the role of the forward-viewing echoendoscope for performing EUS-guided therapeutic interventions.

[Effectiveness of hepatoprotector geptral in the complex treatment of patients with obstructive jaundice]

THE AIM OF THE STUDY

was to improve results of complex treatment of patients with mechanical jaundice using hepatoprotector "Geptral".

MATERIALS AND METHODS

there is shown an experience in complex surgical treatment of 180 patients with mechanical jaundice. Patients were divided into a comparison group (n = 136) received traditional volume of pre-and postoperative treatment, and the main group (n = 44), which in the complex treatment was added hepatoprotector "Geptral" on the developed scheme.

RESULTS

using of the "Geptral" drug in the treatment of patients with obstructive jaundice allowed significantly to reduce the time normalization of porto-hepatic blood flow and performance of the cytolytic and cholestatic syndromes.

CONCLUSION

in the complex treatment of patients with obstructive jaundice and effective patogenic justified is using of "Geptral" hepatoprotector.

[Modified FOLFOX6 treatment for obstructive jaundice caused by hepatic lymph-node metastasis from liver metastases of rectal cancer--a case report]

Chemotherapy is potentially hazardous for patients with liver dysfunction. Although FOLFOX regimen is one of the standard chemotherapies for nonresectable liver metastases of colorectal cancer, the safety of this regimen has not been established yet in patients with obstructive jaundice associated with multiple liver metastases. We report a case of nonresectable liver metastases of rectal cancer treated by modified FOLFOX6 regimen after percutaneous transhepatic biliary drainage for obstructive jaundice, which was caused by hepatic lymph-node metastasis. Five days after giving a birth, a 32-year-old woman underwent Hartmann's procedure for perforation of rectal cancer associated with multiple liver metastases. She was admitted again to receive chemotherapy 35 days after surgery, but the level of total bilirubin was elevated (3.9 mg/dL). Since the total bilirubin level was not rapidly decreased after PTBD, the modified FOLFOX6 regimen was started with a 70% dose. After an introduction of mFOLFOX6 treatment, a biliary-stenting was successfully performed, and the mFOLFOX6 continued with a full dose starting from the 5th cycle. Although the therapeutic efficacy after an additional 8-cycle was classified as stable disease (SD), she did not show any sign of adverse effects except for grade 1 neurotoxicity.

[A case of magnetic compression anastomosis between the common bile duct and the duodenum after distal gastrectomy with Roux-Y reconstruction and cholecystectomy]

An 83-year-old man was admitted to our hospital with jaundice. At the age of 79, he had undergone distal gastrectomy with Roux-Y reconstruction and cholecystectomy due to early gastric cancer and gall bladder carcinoma. CT and MRI revealed severe dilatation from the common bile duct (CBD) to the intra-hepatic bile duct. Blood tests showed high serum levels of bilirubin and CA19-9. Cytology of the bile juice was Class V. Percutaneous transhepatic bile duct drainage was performed. Curative surgical resection was not indicated due to his age and general condition. Neither percutaneous nor endscopical fistulization were successful. Finally magnetic compression anastomosis was performed. Under general anesthesia, the first magnet was placed in the CBD through a cutaneous fistula. The second one was placed in the duodenum through the jejunum. The two magnets attached the walls of the CBD and duodenum. Three weeks after the maneuver, the anastomosis was completed with only a slight fever.

[Diagnostic-treatment algorithm in patients with obstructive jaundice of nontumoral etiology]

Basing on the results of examination and treatment analysis of 273 patients, suffering nontumoral obturation jaundice, clinic-diagnostic algorhythm was developed. Complex diagnosis and treatment were applied to the patients, using miniinvasive (transpapillary, endobiliary) decompression methods with subsequent definite correction of the bile outflow disorders, using laparoscopic or open access, added by hepatoregenerative interventions: reparative hepatic electrocoagulation, selective hepatic vagotomy, periarterial neurectomy of a. hepatic communis and omentohepatopexy.

Preoperative biliary drainage for obstructive jaundice

BACKGROUND

Obstruction in the biliary drainage system causes a rise in serum bilirubin levels (obstructive jaundice). Studies have shown that surgery for severe obstructive jaundice is associated with high peri-operative mortality and morbidity. Jaundice has been considered as a potential risk factor for poor outcome, and pre-operative biliary drainage has been proposed as a method of reversing the pathophysiologic disturbance seen in patients with obstructive jaundice.

OBJECTIVES

To determine the benefits and harms of pre-operative biliary drainage (ie, endoscopic sphincterotomy with stent insertion or percutaneous transhepatic biliary drainage) in obstructive jaundice.

SEARCH STRATEGY

We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (CHBG), the Cochrane Central Register of Controlled Clinical Trials (CENTRAL) in The Cochrane Library, MEDLINE, EMBASE, the Chinese BioMedical Literature on disc (CBM disc), and the Chinese Medical Current Contents (CMCC). All databases were searched up to October 2006.

SELECTION CRITERIA

We considered for inclusion randomised clinical trials comparing biliary drainage followed by surgery and direct surgery performed for obstructive jaundice.

DATA COLLECTION AND ANALYSIS

We collected the available data on the characteristics of the trial, methodological quality of the trials, mortality, morbidity, and hospital stay as reported in each trial. We analysed the data with both the fixed-effect and the random-effects models, using RevMan Analysis. For each outcome, we calculated the odds ratio (OR) with 95% confidence intervals (CI) based on intention-to-treat analysis.

MAIN RESULTS

Five trials with 320 patients (160 in each group) were included. Four trials (n = 235) compared percutaneous transhepatic biliary drainage with direct surgery, and one trial (n = 85) compared pre-operative endoscopic drainage with direct surgery. All trials were of low methodological quality. There was no significant difference in mortality (OR 1.14, 95% CI 0.60 to 2.10) between the pre-operative biliary drainage group and the direct surgery group. No significant difference was found in mortality (OR 1.16, 95% CI 0.56 to 2.41), overall morbidity (OR 1.35, 95%CI 0.48 to 3.83), and in different complications between the percutaneous transhepatic biliary drainage group and the direct surgery group. The trial comparing pre-operative endoscopic drainage and direct surgery showed no significant difference in mortality (OR 1.09, 95% CI 0.32 to 3.68), but found higher morbidity in the endoscopic drainage group. The overall hospital stay was 8 to 17 days shorter in the direct surgery group.

AUTHORS' CONCLUSIONS

Our analyses neither supports nor refutes pre-operative biliary drainage for patients with obstructive jaundice needing surgery. In some specific lesion site it may cause more complications. Pre-operative biliary drainage also prolonged hospital stay and increased cost. However, the strength of evidence is low because of the poor quality of the included trials. More rigorously designed randomised clinical trials with larger sample size and advanced techniques and drugs are needed.

A case of obstructive jaundice caused by impaction of a pancreatic stone in the papilla for which a needle knife precut papillotomy was effective

CONTEXT

Obstructive jaundice in chronic pancreatitis is generally caused by stenosis of the bile duct in the pancreas. Obstructive jaundice caused by the impaction of a pancreatic stone in the papilla is markedly rare, with only seven cases reported to date.

CASE REPORT

We report a case of obstructive jaundice caused by the impaction of a pancreatic stone in the papilla. A 41-year-old male with chronic pancreatitis was admitted because of epigastric pain. Blood analysis revealed increased levels of hepatobiliary system enzymes, mild jaundice and an increase in pancreatic enzymes. Computed tomography revealed a number of pancreatic stones in the main pancreatic duct, and a stone with a diameter of about 1 cm in the pancreatic head. Swelling of the papilla was observed using duodenoscopy while endoscopic ultrasonography revealed a strong echo with acoustic shadows in the papilla. Percutaneous transhepatic biliary drainage was performed for the obstructive jaundice. Contrast medium from the percutaneous transhepatic biliary drainage route regurgitated into the pancreatic duct and revealed the impaction of pancreatic stones in the common channel. The patient was referred to our hospital for treatment of the stone impaction. We performed a needle knife precut papillotomy and extracted a white stone which was diagnosed as a pancreatic stone by composition analysis.

CONCLUSION

Impaction of a pancreatic stone in the papilla is a markedly rare cause of obstructive jaundice in chronic pancreatitis. A needle knife precut papillotomy was effective in removing the impacted pancreatic stone in the papilla.

Tumors of the ampulla of vater: histopathologic classification and predictors of survival

BACKGROUND

The histology and clinical behavior of ampullary tumors vary substantially. We speculated that this might reflect the presence of two kinds of ampullary adenocarcinoma: pancreaticobiliary and intestinal.

STUDY DESIGN

We analyzed patient demographics, presentation, survival (mean followup 44 months), and tumor histology for 157 consecutive ampullary tumors resected from 1989 to 2006. Histologic features were reviewed by a pathologist blinded to clinical outcomes. Survival was compared using Kaplan-Meier/Cox proportional hazards analysis.

RESULTS

There were 33 benign (32 adenomas and 1 paraganglioma) and 124 malignant (118 adenocarcinomas and 6 neuroendocrine) tumors. One hundred fifteen (73%) patients underwent a Whipple procedure, 32 (20%) a local resection, and 10 (7%) a palliative operation. For adenocarcinomas, survival in univariate models was affected by jaundice, histologic grade, lymphovascular, or perineural invasion, T stage, nodal metastasis, and pancreaticobiliary subtype (p < 0.05). Size of tumor did not predict survival, nor did cribriform/papillary features, dirty necrosis, apical mucin, or nuclear atypia. In multivariate models, lymphovascular invasion, perineural invasion, stage, and pancreaticobiliary subtype predicted survival (p < 0.05). Patients with pancreaticobiliary ampullary adenocarcinomas presented with jaundice more often than those with the intestinal kind (p = 0.01) and had worse survival.

CONCLUSIONS

In addition to other factors, tumor type (intestinal versus pancreaticobiliary) had a major effect on survival in patients with ampullary adenocarcinoma. The current concept of ampullary adenocarcinoma as a unique entity, distinct from duodenal and pancreatic adenocarcinoma, might be wrong. Intestinal ampullary adenocarcinomas behaved like their duodenal counterparts, but pancreaticobiliary ones were more aggressive and behaved like pancreatic adenocarcinomas.

[Impact of obstructive jaundice upon hepatectomy: experiment with rats]

OBJECTIVE

To investigate the impact of obstructive jaundice on hepatectomy.

METHODS

120 Wistar rats underwent ligation of the common bile duct to establish animal model of obstructive jaundice. On days 1 after ligation 20 rats underwent 30% hepatic resection + choledochojejunostomy (Group 1) and 20 rats underwent 70% hepatic resection + choledochojejunostomy (Group 2); on day 3 after ligation 10 rats underwent 30% hepatic resection + choledochojejunostomy (Group 3) and 10 rats underwent 70% hepatic resection + choledochojejunostomy (Group 4); on day 5 20 rats underwent 30% hepatic resection + choledochojejunostomy (Group 5) and 20 rats underwent 70% hepatic resection + choledochojejunostomy (Group 6); and on day 7 10 rats underwent 30% hepatic resection + choledochojejunostomy (Group 7) and 10 rats underwent 70% hepatic resection + choledochojejunostomy (Group 8). The serum total protein, albumin, total bilirubin (TBIL), direct bilirubin, and alanine transaminase (ALT) were detected. Then livers were taken out after the rats died or were killed, and the levels of ALT and Na+ K+(-)ATPase were measure.

RESULTS

The serum TBIL peaked on day 3. The survival rate after the operation of Groups 1, 2, 3, 4, 5, 6, 7, and 8 were 20% , 20%, 100%, 50%, 30%, 20%, 0, and 0 respectively.

CONCLUSION

(1) It is the too short a time between two operations, but not liver dysfunction, that is responsible for the high death rate in Groups 1 and 2. (2) 30% hepatic resection + choledochojejunostomy performed 3 days after the ligation of common bile duct is safe with a survival rate of 100%. However, 70% hepatic resection + choledochojejunostomy is dangerous in this time with a survival rate of 50% only. (3) 30% and 70% hepatic resection + choledochojejunostomy performed 5 and 7 days after the ligation are very dangerous with a post-operational survival rate of zero.

[Risk assessment of the acute pancreatitis development after papilla Fateri balloon dilatation]

Data of 241 patients with acute cholecystitis, complicated with obstructive jaundice are analyzed. The risk of the acute pancreatitis development after choledocholithotomy, endoscopic papillosphincterotomy (EPST) and balloon dilatation of the papilla Fateri is assessed. Thus, choledocholithotomy and EPST, combined with the simultaneous manipulations on the terminal part of the common bile duct, are more often followed by the acute pancreatitis. Whereas the balloon dilatation of the papilla Fateri is more often followed by an asymptomatic hyperamylasuria. Demonstrated, that difficulties by papilla Fateri cannulation during EPST furthers the pancreatonecrosis development. The authors suggested a marked balloon catheter, which allows safely and effectively dilate papilla duodeni. The optimal diameter of the balloon is showed to be 1 sm wide.

[Reamberin application in the treatment of obturational jaundice of nontumoral etiology]

The influence of the preparation reamberin on endogenic intoxication severity in the patients, operated on for obturational jaundice of nontumoral etiology, was studied up. In 10 patients 1.5% solution of reamberin, infused continuously intravenously in 400 ml/day dosage during 3-10 days, was applied in complex postoperative therapy. It was established, that obturational jaundice of nontumoral etiology goes together with endogenic intoxication and the antioxidant defence system (ADS) inhibition. The preparation reamberin application had promoted more rapid normalization of the endotoxicosis and ADS indexes, comparing with such in controls.

[Mirizzi syndrome associated with complicated cholelitiasis in the elderly patient. Diagnosis and laparoscopic treatment]

INTRODUCTION

The Mirizzi Syndrome (MS) is a rare variation of cholelitiasis, in which a calculus impacted in the Hartmann Pouch compresses the biliary pathway triggering an obstructive jaundice, frequently followed by inflammatory phenomenon and a number of complications.

OBJECTIVE

To establish the frequency of the Mirizzi Syndrome in complicated cholelitiasis in the elderly patient and analyze the most suitable diagnosis and treatment options.

PATIENTS AND METHOD

Cases of Mirizzi Syndromes in symptomatic inflammatory biliary lithiasis were selected in a five-year period among patients older than 70, who had undergone urgent operation. Epidemiology, private hospital, diagnosis, operating variables, morbility and hospitalization were analyzed.

RESULTS

Twelve (12) patients with Mirizzi Syndrome were detected, with an average age of 77.2 in 197 cases of complicated cholelitiasis. A laparoscopic examination was made in 67% of the cases, with a conversion rate of 50%. The most frequent finding was the biliary extrinsic compression without Csendes-I fistula (58%). The postsurgical morbility was of 58%, including two deaths (17%) and the medium-term postoperative hospital stay was of 9.5 days.

CONCLUSIONS

This research emphasizes the importance of the Mirizzi Syndrome (MS) in the symptomatic cholelitiasis in geriatric patients. This syndrome usually acts like a biliar surgical emergency and the early diagnosis of an elderly patient with jaundice is the key that enables immediate biliary decompression through a cholecystectomy. Management choices are in debate; however, due to its advantages in cases of elderly patients, a laparoscopic treatment is proposed, unless strictly contraindicated.

Percutaneous transhepatic biliary stenting: the first experience and results of the Hospital of Kaunas University of Medicine

Malignant biliary obstruction may be caused by cholangiocarcinoma and other nonbiliary carcinomas. At the time of diagnosis, 90% of patients with malignant obstructive jaundice may benefit from palliative treatment only. The objective of palliation is to relieve jaundice-related symptoms, prevent cholangitis, prolong survival, and improve quality of life. Percutaneous transhepatic biliary stenting is a well-established procedure used in patients with malignant obstruction of intra- and extrahepatic bile ducts. Twelve patients (9 women, 3 men; mean age, 68 years; range, 44-88 years) with inoperable malignant biliary obstruction were selected for percutaneous transhepatic biliary stenting with metallic stents in the period from January to December 2007. Technical and clinical success rate in this patient series was 83% and 80%, respectively. Minor and major complications occurred in 17% and 8% of cases, respectively, which is in the range reported by the others. This is our first experience of percutaneous transhepatic biliary stenting at the Hospital of Kaunas University of Medicine and, to our knowledge, the first reported patient series in Lithuania. These first results encourage expanding effective palliation by the employment of the percutaneous transhepatic biliary stenting in patients with nonresectable malignant biliary obstruction or in case of a recurrent disease after curative surgery. The cost effectiveness of percutaneous transhepatic biliary stenting against percutaneous transhepatic biliary drainage has yet to be evaluated in a prospective manner. However, immediate clinical benefits and positive short-term outcomes are unequivocal.

Role of percutaneous transhepatic biliary drainage in patients with obstructive jaundice caused by local recurrence of gastric cancer

BACKGROUND/AIMS

We reviewed the medical records of patients with obstructive jaundice caused by the local recurrence of gastric cancer to clarify the role of percutaneous transhepatic biliary drainage (PTBD).

METHODOLOGY

Eleven patients with a mean age of 60.1 years (range: 51-71 years) underwent PTBD because of obstructive jaundice caused by the extrahepatic recurrence of gastric cancer.

RESULTS

Jaundice was relieved in all the patients, and the serum total bilirubin (T-bil) level decreased from 12.2 to 2.1 mg/dL. No major complications associated with the execution of PTBD occurred. Although various symptoms caused by jaundice, such as anorexia, itching, nausea, abdominal pain, and fever, were relieved in all the patients within one week after PTBD, general fatigue persisted in 3 patients and abdominal fullness persisted in one. Seven of the 11 patients were discharged from the hospital after the execution of PTBD and remained at home for a median of 93 days. The median survival time (MST) of the remaining 4 patients who could not be discharged was 48 days. Chemotherapy was added in 5 patients after the execution of PTBD; these patients exhibited a significantly longer MST of 247 days, compared to 62 days among the patients who did not receive chemotherapy (P=0.0176).

CONCLUSIONS

PTBD was safely conducted and improved the quality-of-life of patients with obstructive jaundice caused by the local recurrence of gastric cancer. Furthermore, the use of chemotherapy after PTBD might prolong patient survival although RCT (randomized controlled trial) study should be performed to assess the precise effect of chemotherapy after PTBD.

A benign cause of obstructive jaundice with von Hippel-Lindau disease. A case report and review of the literature

CONTEXT

Von Hippel-Lindau disease is a genetic disorder characterized by neoplasms with multiple organ involvement, the pancreas being involved in about half of the cases. Conservative treatment is indicated because the disease is usually asymptomatic with long-term follow-up.

CASE REPORT

We herein present the case of a 64-year-old man with von Hippel-Lindau disease who presented with obstructive jaundice which resulted as being caused by a fibro-cystic pancreatic nodule. In addition, we reviewed the literature concerning pancreatic involvement in von Hippel-Lindau disease with emphasis on their presentation, type of lesions and appropriate management, especially in cases with obstructive jaundice.

CONCLUSION

Conservative management is advocated in the majority of VHL disease patients with pancreatic involvement, but surgery is sometimes required, especially when patients are symptomatic (obstructive jaundice, upper gastrointestinal bleed).

Histological changes at an endosonography-guided biliary drainage site: A case report

Endosonography-guided biliary drainage (ESBD) is a new method enabling internal drainage of an obstructed bile duct. However, the histological conditions associated with fistula development via the duodenum to the bile duct have not been reported. We performed ESBD 14 d preoperatively in a patient with an ampullary carcinoma and histologically confirmed changes in and around the fistula. The female patient developed no complications relevant to ESBD. Levels of serum bilirubin and hepatobiliary enzymes declined quickly, and pancreatoduodenectomy was carried out uneventfully. The resected specimen was sliced and stained with hematoxylin-eosin. Histological evaluation of the puncture site in the duodenum and bile-duct wall, and the sinus tract revealed no hematoma, bile leakage, or abscess in or around the sinus tract. Little sign of granulation, fibrosis, and inflammatory cell infiltration was observed. Although further large-scale confirmatory studies are needed, the findings here may encourage more active use of ESBD as a substitute for percutaneous transhepatic drainage in cases with failed/difficult endoscopic biliary stenting.

[The characteristic of humoral non-specific defence factors in patients with mechanic jaundice according to the methods of drainage of biliary tracts]

The aim of the article was the evaluation of the efficiency of decompression of biliary tracts and determination of optimal period of external draining. The biochemical rates of functional state of liver, dynamic of factors of humeral nonspecific defense in blood serum and bile, in 197 patients with obstructive jaundice were investigated. Concurrently, the dynamic of nonspecific defense reaction changes in infected hepatic bile, changes of amylase, pH, and bile hypertensia were studied. The obtained data are used to determine optimal period of external draining of biliary tracts. The investigation showed that early decompression of biliary tracts allows fast restore of the liver function. Restoration of natural resistance and their positive dynamic depends on the period of performance of external draining; to a lesser degree it depends on the method of performance.