Cases reported "Cholestasis, Extrahepatic"

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1/198. An extrahepatic bile duct metastasis from a gallbladder cancer mimicking Mirizzi's syndrome.

    We report a case of an extrahepatic bile duct metastasis from a gallbladder cancer that mimicked Mirizzi's syndrome on cholangiography. A 67-yr-old woman was admitted to our hospital with a diagnosis of acute calculous cholecystitis. As obstructive jaundice developed after the admission, percutaneous transhepatic biliary drainage was performed to ameliorate the jaundice and to evaluate the biliary system. Tube cholangiography revealed bile duct obstruction at the hepatic hilus, and extrinsic compression of the lateral aspect of the common hepatic duct, with nonvisualization of the gallbladder. No impacted cystic duct stone was visualized on CT or ultrasonography. laparotomy revealed a gallbladder tumor as well as an extrahepatic bile duct tumor. We diagnosed that the latter was a metastasis from the gallbladder cancer, based on the histopathological features. This case is unique in that the extrahepatic bile duct metastasis obstructed both the common hepatic duct and the cystic duct, giving the appearance of Mirizzi's syndrome on cholangiography. Metastatic bile duct tumors that mimic Mirizzi's syndrome have not been previously reported. The presence of this condition should be suspected in patients with the cholangiographic features of Mirizzi's syndrome, when the CT or ultrasonographic findings fail to demonstrate an impacted cystic duct stone.
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keywords = obstruction
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2/198. pancreaticoduodenectomy for chronic pancreatitis: a case report and literature review.

    This is a case report of a patient with chronic pancreatitis who presented with biliary, duodenal and portal vein obstruction, a mass in the head of the pancreas, and a CA 19-9 level of 372 U/ml. Thus, the concern was raised as to the possibility of pancreatic cancer in this patient. We discuss the difficulties in the diagnosis of pancreatic cancer in patients with chronic pancreatitis and the treatment options available for patients with chronic pancreatitis where the significant findings involve the head of the pancreas. Finally, a brief review is given describing the pertinent literature on the surgical treatment of chronic pancreatitis and the current indications of pancreaticoduodenectomy for chronic pancreatitis.
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keywords = obstruction
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3/198. Proximal bile duct stricture caused by a pancreatic pseudocyst: intra-operative placement of a metallic stent.

    A 61 year-old man presented with a proximal bile duct stricture caused by a pancreatic pseudocyst, which is of rare occurrence. Although it could not be determined pre-operatively whether the lesion was caused by cholangiocarcinoma or inflammatory disease, a laparotomy revealed that the proximal extrahepatic bile duct was surrounded and constricted by a pancreatic pseudocyst extending into the hepatoduodenal ligament. Since the stricture was not relieved only by removing the contents of the pseudocyst and surgical biliary diversion was considered too difficult, a self-expandable metallic stent was placed intra-operatively, at the strictured site, under ultrasonic guidance, via the transhepatic approach. The post-operative course of the patient was uneventful, and he remains well 22 months after the operation. The intra-operative placement of a metallic stent into the biliary tract can be an alternative option in the relief of biliary obstruction.
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keywords = obstruction
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4/198. Traumatic neuroma as a cause of obstructive jaundice.

    A 70-year-old man with previous cholecystectomy developed progressive obstructive jaundice, 3 months before hospitalization. Intraoperatively, a 2 x 2 x 1.5-cm mass in the distal part of the right hepatic duct was excised to release complete obstruction. It was verified as traumatic (amputation) neuroma. Despite rarity, traumatic neuroma of the bile duct should be considered in patients who have antecedent surgical procedure of the biliary tract with subsequent occurrence of extrahepatic biliary obstruction.
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keywords = obstruction
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5/198. Biliary ascariasis: CT, MR cholangiopancreatography, and navigator endoscopic appearance--report of a case of acute biliary obstruction.

    A case of acute common bile duct obstruction caused by a roundworm in a 6-year-old girl is reported. Computed tomography (CT) and magnetic resonance imaging (MRI) showed "bull's-eye" and "eye-glass" appearances of the ascaris in the common bile duct. On reformation of the transverse CT and coronal MR images, the tubular ascaris was better depicted. MRI and navigator endoscopic demonstrations of the common bile duct ascaris have not been described previously in the literature. These CT and MRI findings may be helpful in the diagnosis of ascaris.
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keywords = obstruction
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6/198. Obstructive jaundice as the first clinical manifestation of a metastatic malignant melanoma in the ampulla of vater.

    The authors report a patient with obstructive jaundice as the first clinical manifestation of a primary malignant melanoma metastatic in the ampulla of vater. After the histologic diagnosis of the metastases was made, the primary tumor was located in the skin of the back. Obstruction jaundice secondary to ampullary obstruction due to metastatic melanoma has only been reported twice, and in neither case was jaundice the first symptom of the disease.
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keywords = obstruction
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7/198. Carcinoid tumors of the extrahepatic bile duct. A rare cause of malignant biliary obstruction.

    BACKGROUND: Carcinoid tumors of the extrahepatic bile duct are rare and account for 0.2-2% of all gastrointestinal carcinoids. Similar to other tumors of the bile duct, these lesions are difficult to diagnose preoperatively and nearly impossible to distinguish from cholangiocarcinoma. methods: The authors retrospectively analyzed all reported cases of carcinoid tumor of the bile duct and report on two additional cases. RESULTS: Thirty cases of carcinoid tumor of the bile duct have been reported. Among this group were 20 women and 9 men (female-to-male ratio, 2.2:1) with an overall mean age of 47 years (range, 19-79 years). The most common anatomic sites for extrahepatic carcinoid tumors were the common bile duct (58%), perihilar region (28%), cystic duct (11%), and common hepatic duct (3%). jaundice was the most common presenting complaint (55%). Sixty-nine percent of patients with extrahepatic biliary carcinoids had disease confined to the bile duct, whereas 31% had evidence of distant metastases. All patients who presented with localized disease remain disease free with a mean follow-up of 32 months (range, 3 months to 20 years). CONCLUSIONS: carcinoid tumor of the bile duct is a rare form of malignant biliary obstruction. Unlike cholangiocarcinoma, biliary carcinoids occur more commonly in younger patients and in women. Aggressive local invasion by the primary tumor is rare, and metastases occur in less than one-third of patients. All patients who underwent a curative surgical resection were alive and disease free at time of published report, implying a more favorable prognosis. Aggressive surgical resection is recommended.
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ranking = 5
keywords = obstruction
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8/198. Rabdomyosarcoma of the biliary tree.

    Rabdomyosarcoma of the biliary tree is one of the rare causes of biliary tract obstruction in childhood. Nevertheless it is the most common cause of obstructive jaundice due to neoplastic biliary obstruction. We present a two-year-old child with obstructive jaundice secondary to an embryonal rhabdomyosarcoma of the biliary tree. She underwent surgery and, after total excision of the mass, a hepaticojejunostomy and Roux-en-Y anastomosis were performed. She was referred to the Pediatric Oncology Group for follow-up. rhabdomyosarcoma of the bilary tree, although rare, must be considered in the etiology of obstructive jaundice in children.
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ranking = 2
keywords = obstruction
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9/198. Extrahepatic biliary obstruction due to post-laparoscopic cholecystectomy biloma.

    BACKGROUND: jaundice presenting after cholecystectomy may be the initial manifestation of a serious surgical misadventure and requires rigorous diagnostic pursuit and therapeutic intervention. Biloma is a well recognized postcholecystectomy complication that often accompanies biliary ductal injury. CASE REPORT: A 23-year-old female underwent laparoscopic cholecystectomy for symptomatic gallstones and three weeks postoperatively developed painless jaundice. Radiographic and endoscopic studies revealed a subhepatic biloma causing extrinsic compression and obstruction of the common hepatic duct. RESULTS: Percutaneous catheter drainage of the biloma combined with endoscopic sphincterotomy successfully relieved the extrahepatic biliary obstruction and resolved the intrahepatic ductal leak responsible for the biloma. CONCLUSION: Although heretofore undescribed, postcholecystectomy jaundice due to extrahepatic bile duct obstruction caused by biloma may occur and can be successfully treated by means of standard radiologic and endoscopic interventions.
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ranking = 7
keywords = obstruction
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10/198. Obstruction of common bile duct caused by liver fluke--fasciola hepatica.

    Three cases of obstruction of the common bile duct by fasciola hepatica with two of the patients presenting jaundice are reported. The authors have reviewed several publications concerning common bile duct obstruction by liver fluke, a quite rare complication of fascioliasis. Only nineteen cases of common bile duct obstruction caused by fasciola hepatica have been reported in a review of medical publications during last ten years. Clinical presentation, diagnostic methods and considerations, types of surgery are fairly uniform in all of the reported cases. Almost all of patients reviewed, had the history, symptoms and signs characteristic for cholelithiasis including recurrent colic pain in right hypochondriac area, fever or subfebrile temperature, fluctuating or stabile jaundice, and palpable painful gallbladder. The laboratory findings in all cases reviewed had shown leucocytosis, eosinophilia, high or slight elevated serum bilirubin. Echographically commonly revealed dilated intra- and extrahepatic bile ducts containing one or more hyperechogenic elements with or without casting an acoustic shadow. All patients underwent open surgery, comprised with choledochotomy and if possible extraction of the fluke. Only two postoperative cases were of necessity followed by ERCP. In all of our cases the primary pre-operative diagnosis was choledocholithiasis, with diagnose of fascioliasis established at the operation. According to the literature this uncertainty in diagnosis is common because of difficulties in differentiation of fascioliasis versus choledocholithiasis. Considerations for making the differential diagnosis--a history of origin or visiting in endemic area of infection, history of eating of aquatic vegetables, laboratory findings including eosinophilia, fasciola eggs in stool, sonography and radiological imaging results and enzyme-linked immunosorbent essay (ELISA) which has been shown to be rapid, sensitive and quantitative. In all three cases we have observed intraoperative significant signs for liver fascioliasis to include surface scarring of the left lobe on the liver--tracks caused by subcapsular migration and location of the hepatic lesions (these findings were also seen by two authors in literature) with resemblance to Japanese letters. The most effective drug for treatment of fascioliasis according to our experience and literature reviewed is bithionol.
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ranking = 3
keywords = obstruction
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