Cases reported "Jaundice, Obstructive"

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1/124. Obstructive jaundice caused by primary choledochal hydatid cyst mimicking radiologically choledochal cyst.

    A 12-year-old girl with obstructive jaundice that was initially misinterpreted radiologically as having choledochal cyst is presented. A primary hydatid cyst in the wall of the common bile duct causing obstruction was found at operation. The authors emphasize that hydatid cyst should be included in the list of differential diagnoses of obstructive jaundice and cystic lesions located around the biliopancreatic junction in children. ( info)

2/124. Cholestatic jaundice and pseudomembranous colitis following combination therapy with doxorubicin and docetaxel.

    We report a case of cholestatic jaundice and pseudomembranous colitis (PMC) following combination therapy with docetaxel and doxorubicin. This clinical syndrome has not been previously reported with this combination. In particular, this is the first report of non-clostridium difficile-associated PMC with docetaxel-based chemotherapy. Docetaxel is principally metabolized by the hepatic cytochrome p450 mixed-function oxidases, in particular by the isoform CYP3A. This patient was on long-term erythromycin prophylaxis following splenectomy. erythromycin is a known inhibitor of CYP3A. We postulate that erythromycin probably contributed to the observed clinical syndrome. Clinicians should be aware of potential drug interactions, when unusual toxicities occur with novel combinations of chemotherapeutic agents. ( info)

3/124. Transhepatic placement of an enteral stent to treat jaundice in a tumor recurrence obstructed afferent loop after a whipple procedure.

    Tumour recurrence that obstructs the afferent limb, blocking outflow of bile and pancreatic juice, constitutes a major clinical problem after a Whipple procedure. The endoscopic route is often not a possible alternative. Surgery may be difficult and perhaps dangerous to the often very sick patient and decompression with fine bore catheters may lead to cholangitis. External drainage is inconvenient to the patient. The present case describes a less invasive method to provide adequate drainage of the obstructed jejunal limb by insertion of a 22-mm enteral Wallstent transhepatically. The patient became and stayed anicteric during 7 months' follow-up. ( info)

4/124. Schwannoma of the common bile duct: a rare cause of obstructive jaundice.

    The endoscopic diagnosis of bile duct lesions has improved over recent years through the introduction of cholangioscopy and intraductal ultrasound. Combining this with biopsies examined using routinely administered immunohistochemical markers, the diagnosis of tumors of the extrahepatic bile duct can be improved substantially. We report a rare case of a schwannoma of the bile duct causing obstructive jaundice. ( info)

5/124. Inflammatory pseudotumor of the common bile duct.

    An exceptional cause of obstructive jaundice is reported in the present case. A 51-year-old woman progressively developed jaundice with pruritus, and abdominal ultrasonography revealed dilated intra- and extrahepatic bile ducts. Endoscopic retrograde cholangiography and endoscopic ultrasonography showed a tumor in the distal common bile duct, but failed to determine the nature of the lesion, and the patient underwent a pancreaticoduodenectomy. The final diagnosis was an inflammatory pseudotumor of the common bile duct. Inflammatory pseudotumors are uncommon, without evident pathogenesis, and are described in many organs. The localization in the common bile duct is exceptional. The prognosis is good, and a more conservative approach is possible if the diagnosis is certain before surgery. ( info)

6/124. Severe obstructive jaundice in a 90-year-old man caused by an annular pancreas. Report of a case.

    Although the annular pancreas is a rare congenital malformation of the pancreatic glandular parenchyma, this pathology often remains asymptomatic until the adult or old age and can represent an incidental finding during an ERCP or an abdominal Computed tomography, because the clinical appearance of this condition can be of very various kinds. We present a case of an extra-hepatic jaundice in a 90-year-old man, caused by an annular pancreas constricting coledochus. Description of this case results very interesting and particular for two reasons: the very old age of the patient, probably the oldest recorded, and the unusual clinical appearance: obstructive jaundice as beginning one symptom of this malformation. ( info)

7/124. Papillomatosis confined to the distal biliary tract--a rare cause of obstructive jaundice: report of a case.

    Based on the findings of a patient with recurrent obstructive jaundice due to papillomatosis of the distal bile duct, we herein describe the diagnostic difficulties and therapeutic options in this very rare disease. Endoscopic retrograde cholangiopancreatography and, in particular, cholangioscopy are the imaging procedures of choice if biliary papillomatosis is suspected. Due to the tendency of such patients to demonstrate malignant transformation and develop biliary cirrhosis with septic complications, an early and radical surgical resection is recommended in rare cases of localized papillomatosis. This approach may offer the only chance of a cure although the potential risk of multifocal recurrence cannot be ruled out. When considering a radical resection, intraoperative cholangioscopy is strongly recommended to confirm any localized papillomatosis and rule out any diffuse papillomatosis of the entire biliary tract. ( info)

8/124. Cholestatic jaundice caused by sequential carbimazole and propylthiouracil treatment for thyrotoxicosis.

    A 36-year-old Chinese man presented to the Queen Mary Hospital in August 1999 with a 2-week history of jaundice due to propylthiouracil treatment for thyrotoxicosis. He had previously received carbimazole but had developed an urticarial skin rash after 2 weeks of treatment. The patient developed liver failure and fulminant pneumonitis shortly after hospital admission. Despite receiving treatment with broad-spectrum antibiotics and intravenous immunoglobulin, he died 11 days after the onset of the respiratory symptoms. Postmortem examination using electron microscopy showed typical glycogen bodies within the cytoplasm of the hepatocytes, which corresponded to eosinophilic cytoplasmic inclusion bodies visible under light microscopy. Immunohistochemical studies of the inclusion bodies were positive for carcinoembryonic antigen and albumin, and negative for fibrinogen, complement protein C3, immunoglobulins G, M, and A, alpha-fetoprotein, and alpha-1-antitrypsin. This is the first report of a patient who received two sequential antithyroid drugs and developed predominate cholestasis with unique histological features. Extreme caution should be taken when a patient develops allergy to one type of antithyroid drug, because cross-reactivity may develop to the other type. ( info)

9/124. metformin-induced cholestatic hepatitis.

    OBJECTIVE: To report a case of metformin-induced cholestatic hepatitis. methods: We present a detailed case report, including laboratory and biopsy findings. In addition, similar cases from the literature are reviewed. RESULTS: In a 68-year-old man with newly diagnosed diabetes mellitus, metformin therapy was begun. The dosage initially was 500 mg twice daily and later was increased to 850 mg twice a day. Four weeks after met-formin treatment was initiated, jaundice, pruritus, and liver enzyme abnormalities were noted. The patient underwent an extensive work-up, including a hepatitis screen, ultrasonography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography, all of which showed normal findings. A liver biopsy revealed severe cholestasis and mild portal inflammation. Treatment with metformin was discontinued, and the liver enzymes normalized except for a persistently increased level of alkaline phosphatase, most likely related to a prolonged cholestatic effect of metformin. CONCLUSION: Although rare, metformin can be responsible for inducing liver damage, and patients and physicians should be aware of this side effect. ( info)

10/124. Mucin-producing carcinoma of the cystic duct that caused obstructive jaundice.

    We report a very rare case of what appeared to be mucin-producing carcinoma of the cystic duct, and this is the forth case recorded in the English-language and Japanese literature. The patient was a 67-year-old man with a chief complaint of dark urine and jaundice. cholangiography via an endoscopic nasobiliary drain showed dilatation of the common hepatic duct to 14 mm, with no visualization of the cystic duct or gallbladder, and an approximately 15-mm filling defect was observed at the junction of the common bile duct and the cystic duct. Based on these findings a diagnosis of cancer of the middle portion of the bile duct was made. cholecystectomy and resection of the bile duct with dissection of regional lymph nodes and choledochoduodenostomy were performed. About a 1-cm mass was palpable in the region of the cystic duct, and the gallbladder contained mucin some of which reached the common bile duct. Histological examination revealed well-differentiated ductal adenocarcinoma infiltrating the serosa, in which mucus production was observed. The patient was discharged on postoperative day 50. At the present time, 38 months postoperatively, there are no signs of recurrence, and he is attending the outpatient clinical in good health. ( info)
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