Abstract

The present study was carried out to study the cases of obstructive jaundice caused by gall bladder cancer and cholangiocarcinoma. Twenty cases were included in the study. The major aims of the study were to delineate the clinical features and laboratory tests to know the extent of liver damage in patients with obstructive jaundice caused by gall bladder cancer and cholangiocarinoma and to evaluate further the diagnostic accuracy and safety of procedures like ultrasonography, computerized tomography scan, percutaneous transhepatic cholangiography and diagnostic laparoscopy. An attempt was made to evaluate these techniques for the early detection of metastasis and to know the feasibility of surgery, definitive or palliative to relieve obstructive jaundice and its outcome including morbidity and mortality. The study was carried out in MB Government Hospital associated with R.N.T. Medical College, Udaipur. Material and method used in this study include various laboratory investigations including haemogram, blood sugar, urea, creatinine, liver function test, urine examination etc. Investigations like ultrasonography, CT scan, x- ray abdomen and chest and ECG were carried out in hospital. Various procedure e.g., percutaneous transhepatic biliary drainage, diagnostic laparotomy and surgical procedure were performed in hospital. Statistical analysis of various data done which include spectrum of gall bladder cancer and cholangiocarcinoma, distribution of site of pathology in cholangiocarcinoma, age wise distribution, sex wise distribution, area wise distribution, occupation wise distribution, symptomatology, physical findings, laboratory investigation findings, ultrasonography and CT scan reports and various procedures like percutaneous transhepatic biliary drainage, diagnostic laparoscopy and surgery. Jaundice and lump in abdomen were the commonest presenting symptoms in the presenting series. All the twenty patients with gall bladder cancer and cholangiocarcinoma had extreme hyperbilirubinaemia with significant elevation of direct fraction of serum bilirubin level. On ultrasonography and computerized tomography scan 45 percent patients revealed gall bladder stones associated with gall bladder cancer and cholangiocarcinoma. Both of these investigations detected hepatomegaly, dilated intrahepatic biliary radicals and dilated hepatic ducts in 100 percent patients with obstructive jaundice caused by gall bladder cancer and cholangiocarcinoma. In detection of site of mass, liver infiltration, lymph node involvement, ascites and other organ involvement both ultrasonography and CT scan were almost equally effective. Percutaneous transhepatic cholangiography (PTC) was 100 percent effective in showing dilated biliary tree above the level of obstruction in the patients with obstructive jaundice due to gall bladder cancer and cholangiocarcinoma. Diagnostic laparoscopy yielded additional information of the liver and biliary tract and allowed accurate evaluation of extent and degree of neoplasm and involvement of lymph nodes and other organs. Treatment offered was mainly palliative in nature in majority of cases. Non- operative palliation included Percutaneous Transhepatic Biliary Drainage (PTBD) and operative palliation included cholesystectomy along with Roux-en-Y hepatico or choledocho-jejunostomy.

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