Obstructive jaundice secondary to ruptured hepatocellular carcinoma into the common bile duct. Surgical experiences of 20 cases.

Abstract

Hepatocellular carcinoma (HCC) presenting as obstructive jaundice caused by floating tumor debris in common bile duct is rare. Taiwan has a high incidence of HCC and cirrhosis. The authors report their clinical experiences and evaluate the results of different treatment modalities for this disease. A retrospective study was undertaken to review 20 patients with obstructive jaundice secondary to ruptured HCC into common bile duct during the 12 years period. All patients on initial examination had recurrent episodic jaundice or cholangitis. Jaundice was relieved by nonsurgical, percutaneous transhepatic biliary stenting in 4 patients and surgical intubation with T-tube drainage in 16. Types of treatment for those who were treated nonsurgically were percutaneous transhepatic biliary stenting in two patients, followed by transcatheter hepatic arterial embolization in another two patients. For the 16 patients who were treated surgically, the types of treatment were T-tube or Y-tube drainage in 11, T-tube drainage followed by hepatic resection in 2, T-tube drainage and hepatic arterial ligation in 1, and T-tube drainage followed by transcatheter hepatic arterial embolization in the other 2. Liver cirrhosis was the associated disease in 12 (75%). Four patients (20%) died in the hospital. The mean survival time for 12 patients with only surgical or nonsurgical biliary stenting was 3.9 months. For the three patients with percutaneous hepatic arterial embolization, the mean survival time was 8.0 months. Two patients who had undergone hepatic resection had a better postoperative survival time, with one surviving for more than 5 years. Clinical features, types of management, operative findings, and survival in 20 patients with HCC obstructing the common bile duct by tumor thrombi were reviewed. Not all patients with this disease were terminally ill. With proper management, good palliation and occasional cure are possible.