Abstract
BackgroundMDCT cholangiography can be utilized to identify variant biliary anatomy to guide preoperative planning of biliary surgery, and determine the cause and level of biliary obstruction. Early tumor detection and staging of biliary cancer are key factors for a possible cure by surgical resection. Between December 2019 and October 2020, 69 patients with clinically suspected biliary obstruction were enrolled in the study, subjected to clinical assessment (full history taking and clinical examination) and imaging assessment by MDCT cholangiography. Our findings were correlated to standard reference examinations including operative/ERCP/biopsy and histopathology findings.ResultsThe most affected age was between 60 and 70 years old, and males were more affected. The commonest clinical presentation was yellowish discoloration of the skin and sclera followed by biliary colic. Right hypochondrial tenderness was the main clinical finding on clinical examination. Our patients were categorized according to the etiology of biliary obstruction into 7 groups: malignant stricture 52.2% (36 patients), calcular 24.6% (17 patients), iatrogenic 5.8% (4 patients), portahepatis lesions 5.8% (4 patients), benign stricture 4.3% (3 patients), inflammatory 4.3% (3 patients), and congenital 1.4% (1 patient). The malignant group shows dominant mass, moderate biliary obstruction, and arterial and venous enhancement. The overall sensitivity was 94% for malignancy.ConclusionMDCT cholangiography is non-invasive, fast, and highly sensitive and specific in the diagnosis of different causes and levels of biliary obstruction and is useful in the characterization of the lesion in cases of malignant obstruction and differentiating it from benign stricture. It can be used as an effective alternative to ERCP or PTC.
Highlights
multidetector computed tomography (MDCT) cholangiography can be utilized to identify variant biliary anatomy to guide preoperative planning of biliary surgery, and determine the cause and level of biliary obstruction
Enhancement in arterial phase, haziness or stranding of surrounding the fat planes, thickening of the common bile duct wall), congenital lesion in one patient 1.4%, (Fig. 3) and negative in 1 patient 1.4%; from our results, the most frequent group was malignant stricture, and the least frequent group was congenital (Table 1)
(20.3%), periampullary carcinoma in 3 (4.3%) in both, hepatic focal lesions in 3 cases (4.3%) by MDCT compared to 2 cases (2.9%) by gold standard cases, and Gall bladder (GB) and gastric carcinoma (Fig. 5) in one case at each of them (2.9%)
Summary
MDCT cholangiography can be utilized to identify variant biliary anatomy to guide preoperative planning of biliary surgery, and determine the cause and level of biliary obstruction. Obstructive jaundice is a common surgical problem that happens when there is a blockage to the passages of conjugated bilirubin from liver cells to the intestine. This can lead to life-threatening complications such as ascending cholangitis, malabsorption, and hepatorenal syndrome [1]. Direct cholangiography (percutaneous cholangiography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP)) is considered the gold standard technique. They enable direct visualization of the biliary tree and at the same time propose the therapeutic intervention. The drawbacks include invasiveness and even life-threatening complications [12, 13]
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