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Vardevanyan H, Holzinger J, Forstner R. Hepatoduodenal lymph node metastasis mimicking Klatskin tumor in a patient with sigmoid colon mucinous cancer. Radiol Case Rep 2017; 12:494-499. [PMID: 28828110 PMCID: PMC5551956 DOI: 10.1016/j.radcr.2017.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 03/19/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022] Open
Abstract
We report a case of a 48-year-old female patient, who presented with abdominal pain, jaundice, and lack of appetite. Ultrasound showed intrahepatic biliary dilatation with retroperitoneal lymphadenopathy. Further magnetic resonance cholangiopancreatography detected Klatskin tumor. Computed tomography (CT) confirmed the Klatskin tumor with liver metastases and retroperitoneal lymphadenopathy. Biopsy from the hepatic lesion identified mucinous adenocarcinoma, likely originating from bile ducts. Endoscopic retrograde cholangiopancreatography was performed 3 times with stents placed in the left and right hepatic bile ducts. Later the patient had hematochezia and was referred to colonoscopy. Tubulovillous adenoma with dysplasia was diagnosed with signs of in situ cancer. Preoperative CT was done for further staging: new pulmonary metastases were discovered. Sigmoid colon was resected. Histopathology verified a poorly differentiated mucinous adenocarcinoma within the tubulovillous adenoma. Intraoperative biopsies of porta hepatis mass resembled metastatic lymph nodes in hepatoduodenal ligament, mimicking Klatskin tumor. Retrospective analysis of CT data demonstrated presence of sigmoid colon tumor.
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Affiliation(s)
- Hovhannes Vardevanyan
- Department of Diagnostic Imaging, Armenian-American Wellness Center, Sayat-Nova 6, Apartment 11, Yerevan 0001, Armenia
| | - Josef Holzinger
- Department of Endoscopic Surgery, University Hospital of Salzburg, PMU, Salzburg, Austria
| | - Rosemarie Forstner
- Department of Radiology, University Hospital of Salzburg, PMU, Salzburg, Austria
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Percutaneous transluminal forceps biopsy in patients suspected of having malignant biliary obstruction: factors influencing the outcomes of 271 patients. Eur Radiol 2017; 27:4291-4297. [DOI: 10.1007/s00330-017-4796-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 02/20/2017] [Accepted: 03/07/2017] [Indexed: 12/11/2022]
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3
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Colorectal Carcinoma Masquerading Empyema of the Gallbladder: A Case Report with Literature Review. J Gastrointest Cancer 2016; 43 Suppl 1:S60-3. [PMID: 21948294 DOI: 10.1007/s12029-011-9324-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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4
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Yano T, Kobayashi T, Kuroda S, Amano H, Tashiro H, Ohdan H. Obstructive jaundice caused by a giant liver hemangioma with Kasabach-Merritt syndrome: a case report. Surg Case Rep 2015; 1:93. [PMID: 26943417 PMCID: PMC4595412 DOI: 10.1186/s40792-015-0095-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 10/01/2015] [Indexed: 02/06/2023] Open
Abstract
Hemangioma is the most common benign tumor of the liver. Liver hemangioma (LH) usually remains asymptomatic, but the most common symptoms associated with LH are abdominal pain and discomfort. LH is an uncommon cause of bile duct dilatation and obstructive jaundice. An 83-year-old Japanese woman who received hemodialysis at another hospital was referred to our hospital because of abnormal liver function and obstructive jaundice. Abdominal computed tomography and magnetic resonance imaging revealed a 13-cm tumor in liver segments IV–V and intrahepatic bile duct dilatation. Endoscopic retrograde cholangiopancreatography revealed extrinsic compression of the bile duct at the hepatic hilar region. Laboratory tests showed that the patient had low platelet counts and low fibrinogen levels. Because the patient had hyperbilirubinemia and Kasabach-Merritt syndrome, we performed a segmentectomy of liver segments IV and V. Histological examination showed hemangioma of the liver. The patient’s thrombocytopenia and coagulopathy improved immediately after surgery. In conclusion, LH is a very rare cause of obstructive jaundice. LH has the potential to compress the bile duct and cause obstructive jaundice.
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Affiliation(s)
- Takuya Yano
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Tsuyoshi Kobayashi
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Shintaro Kuroda
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hironobu Amano
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hirotaka Tashiro
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
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Lee DH, Ahn YJ, Shin R, Lee HW. Metastatic mucinous adenocarcinoma of the distal common bile duct, from transverse colon cancer presenting as obstructive jaundice. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2015; 19:125-8. [PMID: 26379735 PMCID: PMC4568601 DOI: 10.14701/kjhbps.2015.19.3.125] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/06/2015] [Accepted: 08/01/2015] [Indexed: 12/04/2022]
Abstract
The patient was a 70-year-old male whose chief complaints were obstructive jaundice and weight loss. Abdominal imaging studies showed a 2.5 cm sized mass at the distal common bile duct, which was suggestive of bile duct cancer. Eccentric enhancing wall thickening in the transverse colon was also shown, suggesting concomitant colon cancer. A colonoscopy revealed a lumen-encircling ulcerofungating mass in the transverse colon, that was pathologically proven to be adenocarcinoma. The bile duct pathology was also adenocarcinoma. Pylorus-preserving pancreaticoduodenectomy and extended right hemicolectomy were performed under the diagnosis of double primary cancers. Postoperative histopathologic examination revealed moderately differentiated mucinous adenocarcinoma of transverse colon cancer, and mucinous adenocarcinoma of the distal common bile duct. Immunohistochemical staining studies showed that the bile duct cancer had metastasized from the colon cancer. The patient recovered uneventfully from surgery and will be undergoing chemotherapy for three months.
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Affiliation(s)
- Doo-Ho Lee
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Joon Ahn
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Rumi Shin
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Hae Won Lee
- Department of Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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6
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Gupta A, Noba AL, Gupta S, Arora VK, Rathi V, Kumar S. Papillary cystadenocarcinoma of ovary presenting as obstructive jaundice: a rare presentation. Oman Med J 2012; 27:159-60. [PMID: 22496943 DOI: 10.5001/omj.2012.32] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 01/21/2012] [Indexed: 12/29/2022] Open
Abstract
Obstructive jaundice resulting from malignancy of gastrointestinal tract and hepatobiliary tract has been reported in various studies. Ovarian malignancy leading to obstructive jaundice due to portal lymphadenopathy is of rare occurrence. We report a case presented with obstructive jaundice and on further evaluation, found to have ovarian papillary cyst adenocarcinoma with secondaries at porta hepatis which was managed successfully by neoadjuvant chemotherapy followed by cytoreductive surgery.
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Ito K, Taira K, Arii S. Intrahepatic bile duct dilatation with a liver cyst and hemangioma: report of a case. Surg Today 2009; 39:256-60. [PMID: 19280288 DOI: 10.1007/s00595-008-3831-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Accepted: 05/28/2008] [Indexed: 11/25/2022]
Abstract
We report a case of intrahepatic bile duct dilatation with a liver cyst and hemangioma. A 58-year-old woman was referred for investigation of a cystic lesion and peripheral intrahepatic bile duct dilatation in the left lateral segment of the liver. Abdominal computed tomography (CT) and magnetic resonance imaging (MRI) showed dilatation of the intrahepatic bile ducts in the left lateral segment, near a 4.5-cm cystic lesion. Early enhancement into the delayed phase was seen in the dorsal part of the cystic lesion. Celiac angiogram showed a belt-shaped hypervascular area, but no encasement or irregularity of the artery. To exclude malignancy, we performed a left lobectomy. Microscopically, the cyst was lined with a single layer of flattened epithelial cells and a spongy tumor was diagnosed as cavernous hemangioma, which compressed the bile duct. The histopathological diagnosis was biliary stenosis associated with cavernous hemangioma of the liver. Invasive surgery may be avoided by awareness of this unusual benign pathology.
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Affiliation(s)
- Koji Ito
- Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, Graduate School of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
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Morelli L, Faraci R, Piscioli I, Pusiol T, Del Nonno F, Licci S. Colon carcinoma metastasis to the intrapancreatic tract of the common biliary duct: a first case report. Scand J Gastroenterol 2007; 42:777-8. [PMID: 17506002 DOI: 10.1080/00365520601075852] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Jaundice, a common feature of advanced colon cancer, is usually due to liver parenchyma metastasis, but it can sometimes be caused by extrahepatic biliary obstruction. This rare event is related to metastasis to the lymph nodes placed behind the duodenum, along the choledochus or the vena porta, extrinsically compressing the common duct. Stenosis of the common bile duct secondary to parietal metastatic involvement is extremely rare. We report on a case of colon carcinoma metastasis to the intrapancreatic tract of the common bile duct, with a review of the literature.
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Affiliation(s)
- Luca Morelli
- Department of Pathology, S. Maria del Carmine Hospital, Rovereto, Italy.
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Okamoto T, Yanagisawa S, Fujioka S, Gocho T, Yanaga K, Kakutani H, Tajiri H. Is metallic stenting worthwhile for biliary obstruction due to lymph node metastases? J Surg Oncol 2006; 94:614-8. [PMID: 17048236 DOI: 10.1002/jso.20614] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The indications for metallic stents have widened from primary hepatobiliary cancers to the other diseases such as lymph node metastases from distant organs. The present study aimed to evaluate the results and establish the efficacy of metallic stenting in patients with obstructive jaundice due to metastatic lymph nodes. METHODS Stent patency, survival and cost per patient until death were retrospectively compared between patients with primary carcinoma of the biliary tract (PC group; n = 71) and lymph node metastases from the gastric and colorectal carcinomas. (LN group; n = 26). RESULTS Stent occlusion occurred in 17 patients in the PC group (24%). In contrast, stent occlusion was significantly more frequent in the LN group (P = 0.0293), occurring in 13 patients (50%). Cumulative stent patency was also significantly shorter in the LN group than that in the PC group (P = 0.0016). However, survival was almost the same between the two groups. The mean medical fee was 27% higher for the LN group than for the PC group, which was attributable to additional treatment for stent occlusion. DISCUSSION The indications for metallic stent placement for biliary obstruction caused by lymph node metastases from the gastrointestinal tract seem limited. Further investigation of the treatments alternative to metallic stents would be required.
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Affiliation(s)
- Tomoyoshi Okamoto
- Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
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Youssef SS, Kumar PP. Jaundice secondary to isolated porta hepatis metastasis in colorectal cancer: case report and review of the literature. South Med J 2004; 97:287-90. [PMID: 15043338 DOI: 10.1097/01.smj.0000076707.95919.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Colorectal cancer occurs mainly after the age of 50. The liver is the most frequent site of metastases, although isolated metastases to the porta hepatis are rarely reported in the literature. From 1924 to 1993, only 16 cases of periportal lymph nodes metastases were reported. We report a case of jaundice secondary to porta hepatis metastases from primary colorectal cancer. The appearance of symptoms was concurrent with the elevation of carcinoembryonic antigen in our case. This emphasizes the importance of polymerase chain reaction to detect the small amount of carcinoembryonic antigen transcript in blood or in peritoneal fluid before the appearance of symptoms. Polymerase chain reaction allows the prediction of high risk of recurrence and the presence of micrometastases. More trials are needed to assess the outcome after treatment by adjuvant chemotherapy for micrometastases.
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Affiliation(s)
- Souad S Youssef
- Division of Radiation Oncology, James H. Quillen College of Medicine, East Tennessee State University, James H. Quillen Veterans Affairs Medical Center, Johnson City, TN, USA
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Jung GS, Huh JD, Lee SU, Han BH, Chang HK, Cho YD. Bile duct: analysis of percutaneous transluminal forceps biopsy in 130 patients suspected of having malignant biliary obstruction. Radiology 2002; 224:725-30. [PMID: 12202706 DOI: 10.1148/radiol.2242011501] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate percutaneous transluminal forceps biopsy in patients suspected of having a malignant biliary obstruction. MATERIALS AND METHODS One hundred thirty consecutive patients (82 men and 48 women; mean age, 59 years) with obstructive jaundice underwent transluminal forceps biopsy during or after percutaneous transhepatic biliary drainage. The lesions involved the common bile duct (n = 58), common hepatic duct (n = 39), hilum (n = 14), ampullary segment of the common bile duct (n = 11), right or left intrahepatic bile duct (n = 5), or the entire extrahepatic bile duct (n = 3). In each patient, three to five specimens (mean, 4.1 specimens) were taken from the lesion with 5.4-F biopsy forceps. The final diagnosis for each patient was confirmed with pathologic findings at surgery, additional histocytologic data, or clinical and radiologic follow-up. Statistical analysis was performed with the chi(2) test; a P value < or =.05 was considered to indicate a significant difference. RESULTS Ninety-eight of 130 biopsies resulted in correct diagnoses of malignancy. Five biopsy diagnoses proved to be true-negative. There were 27 false-negative diagnoses and no false-positive diagnoses. The diagnostic performance of transluminal forceps biopsy in malignant biliary obstructions was as follows: sensitivity, 78.4%; specificity, 100%; and accuracy, 79.2%. Sensitivity of biopsy in the 82 patients with cholangiocarcinoma was higher than in the 43 patients with malignant tumors other than cholangiocarcinoma (86.6% vs 62.8%, P <.005). Sensitivity was significantly lower in the ampullary segment of the common bile duct than in other sites (P <.01). No major complications related to the biopsy procedures occurred. CONCLUSION Percutaneous transluminal forceps biopsy is a safe procedure that is easy to perform through a transhepatic biliary drainage tract. It provides relatively high accuracy in the diagnosis of malignant biliary obstructions.
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Affiliation(s)
- Gyoo-Sik Jung
- Department of Diagnostic Radiology, College of Medicine, Kosin University, 34 Amnam-Dong, Seo-Gu, Pusan 602-702, South Korea.
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Abstract
Forty-one patients with extrahepatic biliary obstruction by metastatic gastric carcinoma underwent retrospective study to determine demographics, clinical features, laboratory findings on presentation, time interval from previous gastrectomy, level of biliary obstruction, methods of palliation, complications from treatment, treatment results, and survival. Thirty-seven patients underwent biliary decompression by percutaneous transhepatic biliary drainage (PTBD) (35 patients), endoscopic insertion of plastic stent (one patient), and operative insertion of T tube (1 patient). The remaining 4 patients had no biliary drainage procedure performed. Subsequently expandable metallic biliary stents were inserted in 9 patients through the PTBD tract. Two patients received postdrainage external irradiation. Reduction in serum total bilirubin was seen in all patients after drainage. Two patients were alive at the time of this analysis. The median survival of these 41 patients was only 70 days. The 6- and 9-month survival rates were 27.0% and 9.7%, respectively. Hemoglobin (p < 0.001) and total bilirubin (p < 0.002) on presentation were found to be independent factors predicting survival. Extrahepatic biliary obstruction by metastatic gastric carcinoma was associated with poor survival. Patients with profound anemia or jaundice on presentation carried the worst prognosis.
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Affiliation(s)
- K M Chu
- Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, China.
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Ritota PC, Quirke TE, Keys RC, Byer A. Metastatic endometrial carcinoma: rare cause of extrahepatic obstructive jaundice. J Surg Oncol 1996; 61:61-2. [PMID: 8544462 DOI: 10.1002/(sici)1096-9098(199601)61:1<61::aid-jso13>3.0.co;2-#] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We report a very rare case of endometrial carcinoma causing extrahepatic bile duct obstruction. Management of this case and probable mechanism of spread are presented.
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Affiliation(s)
- P C Ritota
- Department of Surgery, Hackensack Medical Center, NJ 07601, USA
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Anderson ID, Manson JM, Martin DF, Tweedle DE. Relief of metastatic biliary obstruction by stent placement: is it worthwhile? Surg Oncol 1993; 2:113-7. [PMID: 7504561 DOI: 10.1016/0960-7404(93)90020-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Twenty-one patients undergoing stent placement for extra-hepatic biliary obstruction by metastatic disease were reviewed. Primary tumours (colorectal 8, stomach 4, breast 2, ovary 2, others 5) had been diagnosed 13 months (median) before presentation with bile duct obstruction, which was at the porta hepatis or common hepatic duct in 14 patients and in the common bile duct in seven. Endoscopic stent placement was achieved in 14 out of 20 patients in whom it was attempted. A percutaneous trans-hepatic procedure was necessary in five patients. Two patients could not be stented. Median survival was 5 months (range 1 month to 6 years) in patients stented successfully but only 1 month (2 weeks to 3 months) in unsuccessful cases (P < 0.01). Nine patients survived more than 4 months. Patients with proximal obstruction fared less well than those with distal obstruction; they required more procedures and survived for shorter periods (median 1 month versus 5 months, P < 0.05). Worthwhile palliation is afforded to almost half these patients by endoscopic stent placement and individual patients may achieve prolonged, symptom-free survival.
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Affiliation(s)
- I D Anderson
- Department of Surgery, University Hospital of South Manchester, UK
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Bear HD, Turner MA, Parker GA, Lawrence W, Horsley JS, Messmer JM, Cho SR. Treatment of biliary obstruction caused by metastatic cancer. Am J Surg 1989; 157:381-5; discussion 385. [PMID: 2467569 DOI: 10.1016/0002-9610(89)90580-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Over an 8-year period, among 41 patients with obstructive jaundice caused by metastases to the liver or lymph nodes adjacent to the porta hepatis, palliative biliary decompression was established surgically in 11, by percutaneous transhepatic biliary drainage (PTBD) in 25, and by both methods in 2. Three patients had no drainage procedure performed. Early mortality after drainage occurred in 6 of 38 patients, and the median survivals (actuarial) for the remaining 32 patients were 4.5 months for the surgical group (range 2 to 21 months) and 4 months for the PTBD group (range 2 to 14 months). Although there were trends toward more frequent hospital readmissions and episodes of cholangitis in the PTBD group, the only statistically significant difference was in the number of catheter manipulations required. We concluded that when patients develop obstructive jaundice as a manifestation of metastatic cancer, useful palliation can be achieved by either surgical or percutaneous decompression.
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Affiliation(s)
- H D Bear
- Division of Surgical Oncology, Medical College of Virginia Station, Richmond 23298-0011
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Abstract
Obstructive jaundice due to metastatic lymphadenopathy in the region of the common bile duct has been reported in many malignancies, but never previously as the presenting symptom in ovarian cancer. A case in point is presented.
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Affiliation(s)
- M Rosenblatt
- Department of Radiology, Maimonides Medical Center, Brooklyn, New York
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Praderi RC, Estefan AF, Tiscornia E. Transhepatic intubation in benign and malignant lesions of the biliary ducts. Curr Probl Surg 1985; 22:1-88. [PMID: 3915735 DOI: 10.1016/0011-3840(85)90010-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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