Mechanical Jaundice Research Articles

Features of the clinic in patients with non-tumor mechanical jaundice with concomitant pathology

The Objective was to improve the results of diagnostics of the severity of patients with complications of cholelithiasis, occurring in the form of mechanical jaundice, against the background of comorbidity.Methods and Materials. 537 patients admitted in the clinic of hospital surgery of Kabardino-Balkar State University named after H. M. Berbekov in the period from 2010 to 2019 were examined. The terms of admission to the hospital were different. 25 (4.6 %) people were admitted in a short period of time up to 6 hours. A day after the onset of the disease – 82 (15.3 %) people. More than half – 277 (51.6 %) people were hospitalized a week after the onset of the disease. We analyzed the data of comorbidity scales of CIRS, Kaplan–Feinstein and Mary Charlson Index, as well as biochemical criteria reflecting the severity of calculous cholecystitis, jaundice and concomitant diseases.Results. As a result of their analysis and comparison, we found that comorbidity in patients of this kind is the main aggravating factor and worsens the пeneral condition as the stages of jaundice develop.Conclusion. We found out that a common biochemical tests as for characterizing changes of the hepatocyte in nontumor obstructive jaundice, and for evaluating the degree of impact of comorbidity are the content of blood alkaline phosphatase, creatine phosphokinase and transaminases. Intoxication syndrome in patients with cholangitis and comorbidity so negatively affect all organs and systems of the body that it can lead to inoperability.

The 93 years Old Patient with Jaundice Caused by a Hepatic Artery Aneurysm. Case Report with Literature Review

The hepatic artery aneurysm (HAA) is a rare cause of cholestasis. The course of HAA, even in 75% of cases is asymptomatic. 14% of cases are complicated by rupture and hemorrhage. Before the development of imaging techniques such as computed tomography or ultrasound, the diagnosis of HAA was stated on the ground of the autopsy or during the laparotomy. Today a detection of an aneurysm is more often earlier, which enables successful treatment. 92.4% of visceral artery aneurysms are diagnosed accidentally during imaging in asymptomatic patients. The patient with an aneurysm of the hepatic artery causing mechanical jaundice, described by us is, to our knowledge, the oldest case report published. The literature review was performed using the database PubMed using the keywords and aneurysm,. To identify additional potentially relevant data sources, we hand-searched the reference lists of the retrieved studies. Reports from 1834 to 2021 concerning mechanical jaundice caused by an aneurysm of visceral arteries were selected. The analysis included studies in which it was possible to determine the procedure, treatment results, and the artery with which the aneurysm was involved. In the reviewed works from 1834 to 2021, 77 cases were described. The oldest case so far was an 89-year-old woman, while the oldest men with this condition were 85 years old. Mechanical jaundice caused by the compression of HAA may occur in patients in their 90-ties and needs endovascular or surgical intervention.

Management of obstructive jaundice in patients with neoplasms of the major duodenal papilla

To develop the indications and assess an effectiveness of treatment of patients with ampullary tumors followed by mechanical jaundice. There were 26 patients with major duodenal papilla neoplasms for the period 2015-2020 at the Sklifosovsky Research Institute for Emergency Care. Twenty patients underwent transpapillary interventions: papillosphincterotomy followed by lithoextraction and bilio-duodenal stenting in 4 (15.3%) patients, bilio-duodenal stenting in 12 (46.1%) patients, nasobiliary drainage in 2 (7.6%) patients, pancreaticoduodenal stenting in 2 (7.6%) patients. Percutaneous transhepatic microcholecystostomy was performed in 6 (23.4%) patients. In all cases, laboratory values decreased in 5-7 days after drainage. Eight (30.7%) patients refused further surgical treatment and were discharged in satisfactory condition. Another 8 (44.5%) patients underwent endoscopic submucosal papillectomy. There were no postoperative complications. Patients were discharged after 5-7 days. Four (22.2%) patients underwent tumor resection via laparotomy. One of these patients required redo laparotomy in postoperative period due to acute perforated duodenal ulcer. Six (33.3%) patients underwent palliative bilio-duodenal stenting. Invasion of muscle layer or distal parts of the common bile duct, as well as abnormal vascularization are indications for open surgery or palliative endoscopic treatment. Tumor location within mucous and muscle layers without invasion of distal third of the common bile duct and no abnormal vascularization of tumor justify endoscopic papillectomy. Endoscopic approach can be considered as a final minimally invasive method with minimal risk of postoperative complications in case of benign ampullary tumor.

Experimental Mechanical Jaundice: Morphological Aspects of Proliferation, the Possibility of Transformation and Involution of Epithelial Cells in the Bile Ducts

On an experimental model of obstructive jaundice in experimental rats, the cytological aspects of proliferation and the possibility of transformation of cholangiol cells into hepatocytes, as well as the cellular mechanisms of involution of the bile ducts, were investigated. The material was the liver of sexually mature rats (n=38) with 10, 20, and 25 days of cholestasis, in which the duct was recanalized during these periods and sacrificed on the 5th, 10th, 15th, 30th and 90th days after the second operation. Pieces of liver tissue were processed by conventional histological and electron microscopic methods. Ligation of the bile duct promotes rapid proliferation of the bile ducts, which correlates with the duration of cholestasis. In the early stages of the experiment (cholestasis for 10 days), the bile ducts occupy the peripheral sections of the lobules, by the 20th day, cholestasis penetrates deeply into the lobule, dismembering it into fragments, and by the 25th day, a picture of biliary cirrhosis develops. It was found that the proliferation of the bile ducts occurs due to the duct cells themselves, the transformation of cholangiol cells into "oval" cells or hepatocytes was not found. The transformation criteria were the shape, intracellular structures, and the state of the boundary plate and the basement membrane of the ducts. Consequently, bile duct cells (cholangioli) and hepatocytes, diverse in their function, showed absolute genetic heterogeneity. After the restoration of the outflow of bile, non-functioning ducts undergo destruction and decay. It has been shown that hepatic macrophages play an active role in cleansing the liver parenchyma from the products of cellular decay of the bile ducts, dead liver cells, as well as excess fibrillar structures. Activated Kupffer cells, due to the content of a large number of heterolysosomes, provide degradation, lysis and utilization of cellular and extracellular structures.

Comparative evaluation of the results of the application of gallery orption in patients with mechanical jaundice malignant etiology

Comparative evaluation of the results of the application of gallery orption in patients with mechanical jaundice malignant etiology

The acute cholecystitis in COVID-19 patients: treatment in conditions of reprofiled hospital

Introduction. Routine surgical care has been suspended during the COVID-19 pandemic. For the treatment of patients with acute cholecystitis, conservative treatment, percutaneous drainage of the gallbladder or cholecystectomy is offered. Tactics of treatment of patients with acute cholecystitis against the background of COVID-19 have not been studied. It is important to study the data concerning the time of cholecystectomy in acute cholecystitis, comparing “early” and “delayed” cholecystectomy, which is performed after a period of conservative therapy. Aim. To present and evaluate the results of treatment of patients with acute cholecystitis against the background of COVID-19 in the conditions of a repurposed multi-specialty hospital on the basis of the O. M. Filatov Clinic Hospital No. 15 in Moscow. Material and methods. A retrospective comparative study with history control included 16 patients with acute cholecystitis against the background of COVID-19. Mechanical jaundice syndrome was diagnosed in 3 (18.75%) patients. The diagnosis of coronavirus infection using PCR was confirmed in 5 patients, serological method-in 2 patients, and in 9 patients the diagnosis was confirmed by X-ray or CT examination with negative/doubtful PCR test results. Results. Nine (56.25%) patients were operated 4 (25%) percutaneous interventions were performed, in 3 (18.75%) cases conservative therapy was performed. Most patients were operated on within the first day of admission. In the main group, a fatal outcome occurred in 1 (6.25%) case (death from a thromboembolic complication in a patient with mechanical jaundice syndrome). Discussion. The choice of «early» cholecystectomy for acute cholecystitis, provided the condition is stable and the initial changes in the lungs are appropriate in most COVID-19 patients. Conclusion. Performing cholecystectomy in patients with coronavirus infection in an infectious hospital did not lead to an increase in the duration of inpatient treatment and the prevalence of complications. The approaches mentiobed in the results section can be used as a safe method in the discussed category of patients.

The effect of hyperbilirubinemia on pain intesity in patients with pancreatobiliaric cancer during perioperative period

The aim was to assess the effect of hyperbilirubinemia on the severity of pain syndrome in patients with pancreatobiliary cancer during perioperative period. Materials and methods. The results of surgical treatment of 218 patients with pancreatobiliary cancer complicated by the development of mechanical jaundice syndrome, who underwent pancreatoduodenal resection, were analyzed. The severity of pain was assessed on a visual-analog scale, as well as subscales of questionnaires EORTC QLQ-C30 and SF-36. Results. At the time of admission to the hospital the initial level of total bilirubin was 274.3 ± 5.9 μmol/L, direct - 211.2 ± 2.2 μmol/L, indirect – 63.4 ± 2.6 μmol/L. The intensity of pain syndrome on admission was 4.9 ± 0.4 points. In the early, late and late postoperative period the intensity of pain decreased, respectively, from 6.4 ± 0.3 to 2.8 ± 0.4 points. Conclusions. A strong positive correlation between the intensity of pain syndrome and the level of cholemia was determined (r = 0.74).

Transduodenal laparoscopic papillectomy for adenoma of major duodenal papilla

A 60-year-old man admitted to the clinical center due to weakness, episodes of jaundice. The laboratory date revealed elevated levels of total bilirubin—112.5 μmol/l (range 8,5–20,5 μmol/l) and direct bilirubin—60.8 μmol/l (range 4,3–4,6 μmol/l), elevated hepatic enzymes (aspartate aminotransferase [AST]: 95 U/l (range ≤ 40 U/L), alanine aminotransferase [ALT]: 301 U/l (range ≤ 30 U/L). When performing esophagogastroduodenoscopy, a polyp of the large duodenal papilla with a spread to the terminal parts of the bile and pancreatic ducts was revealed, and a biopsy was taken. Histological examination detected tubulovillous adenoma with epithelial dysplasia II–III stage. DS: “Tubulovillous adenoma of the major duodenal papilla with epithelial dysplasia II–III”. Complications: “Multiple choledocholithiasis. Mechanical jaundice. Liver failure.” Considering the inability to carry out endoscopic treatment, recurrent nature of the jaundice it was decided to perform surgery: laparoscopic duodenotomy, papillectomy, choledocholithotomy, performing of choledochoduodenal anastomosis, duodenoplasty and abdominal drainage. The postoperative period was taking its normal course. Duration of staying in the intensive care unit—4 days. Enteral fluid intake started on the 2-nd postoperative day. Enteral feeding was restored in a 3 days. Polyps of the large duodenal papilla are relatively rare form of tumors of the gastrointestinal tract, which may not manifest clinically, or, as the above case, lead to severe pathological conditions. Currently, there is no single approach to the treatment of this group of diseases. Some authors propose a pancreatoduodenal resection, but the risks of this operation associated with high postoperative morbidity and mortality are not always justified. The case is unique because the described procedure is less invasive and affects the minimum number of organs. Laparoscopic approach has significant advantages in the treatment of this infrequent pathology.

EXPERIENCE IN PERFORMING PUNCTURE AND DRAINAGE MINI-INVASIVE INTERVENTIONS UNDER ULTRASOUND CONTROL IN THE DIAGNOSIS AND TREATMENT OF ABDOMINAL DISEASES AND POSTOPERATIVE COMPLICATIONS. Review

The article presents a description of the main puncture and drainage interventions, indicating the method of their implementation, techniques, materials used for their implementation. The own experience of application of the specified minimally invasive interventions in the treatment of a syndrome of mechanical jaundice of benign and malignant genesis, acute cholecystitis, acute pancreatitis and its complications, hepatic abscesses, limited liquid accumulations of an abdominal cavity and retroperitoneal space is described. The advantages and disadvantages are noted, a comparative assessment is made and recommendations are given for the use of different puncture and drainage interventions depending on the type of pathology in which they are used.

Analysis of neutrophils functional activity in men with mechanical jaundice of various genesis.

Obstructive jaundice (OJ) or blockage of the bile duct code K83.1 (according to ICD 10), occurs in approximately 45-50% of cases of all varieties of jaundice, it can be both non-tumor and tumor genesis. The functional pathway plays a special role in the genesis of complications of breast the activity of neutrophils as key effector cells responsible for the development of the inflammatory process in the breast. Investigation of the metabolic mechanisms of the functioning of neutrophils allows us to identify intracellular targets, when exposed to It was possible to modulate the level of cell reactivity.The study used data from 47 men with obstructive jaundice of non-tumor origin and 45 men with obstructive jaundice of tumor origin (stage I-II of the tumor process). As a control, data from 100 practically healthy men were used. A pronounced change in the kinetics of the chemiluminescent response of neutrophils in men with obstructive jaundice was found, consisting in an increase in the time to reach the maximum intensity, maximum intensity, area under the curve and activation index for both spontaneous and luminol-dependent induced chemiluminescence. The development of the tumor process in this category of patients was accompanied by a decrease in the area parameter under the curve during spontaneous and induced reactions, time to maximum, intensity maximum and activation index during spontaneous chemiluminescence. The data obtained indicate a marked increase in the values of the functional activity of neutrophils in patients with obstructive jaundice of benign origin, as well as a sharp decrease in their values in the presence of a pathological process of malignant origin.

Features of mechanical jaundice course caused by complications of bile disease

The OBJECTIVE was improving the results of diagnostics and assessment of the severity of patients with mechanical jaundice (MJ) at various stages of its development.METHODS AND MATERIALS. The basis of clinical and laboratory research was the data of 537 patients who were admitted during the period from 2010 to 2019. Principles of separation at the stage of the course of mechanical jaundice of non-tumor Genesis.RESULTS. Analysis of clinical and laboratory studies showed characteristic signs of various complications of cholelithiasis, accompanied by mechanical jaundice. Then, on this basis, specific symptoms characteristic of each stage of mechanical jaundice of non-tumor Genesis were determined.CONCLUSION. The course of mechanical jaundice, which develops with complications of cholelithiasis, has a phase-stage character, beginning with extrahepatic cholestasis, then-joining hepatocytolysis and ending with cholangitis. Initially, cholestasis and cytolysis are functional, which is confirmed by biochemical tests, so these processes are labile and reversible. This makes it possible to effectively use biliary decompression methods and infusion therapy with detoxification during treatment. Cholangitis is characterized by destructive morphological manifestations, so it is verified by specific clinical symptoms and laboratory tests characteristic of inflammatory-septic reactions and progresses to sepsis. Differentiation of stages of mechanical jaundice allows to personify surgical and conservative treatment of such patients.

CHOLANGITIS AS A SYSTEMIC MANIFESTATION OF ACUTE BILIARY INFECTION

The main causes of cholangitis are hypertension in the biliary ducts and infection. In order to determine the place of the infectious factor in the acute cholangitis development, a retrospective and prospective analysis of case histories of 176 patients with choledocholithiasis and manifestations of acute and chronic cholangitis was performed. Bile from the common bile duct in the patients with obstruction of the biliary tract was studied. In the patients with mechanical jaundice without and with cholangitis, the intraductal pressure in the common bile duct averaged 227.3±26.1 mm of water column, in the patients without signs of cholangitis that was 97.5±8.3 mm of water column. With mechanical jaundice without acute cholangitis, it was slightly elevated if compared to normal. This suggests that the increase in pressure in the bile ducts in acute cholangitis is not influenced by the fact of obstruction of the biliary tract, and the development of the inflammatory process in them. In the patients with cholangitis, the initial values of the number of colonizing units were much higher than in "pure" choledocholithiasis. After endoscopic papillosphincterotomy in the patients with vivid clinical cholangitis, in whom decompression was achieved, in the control study, this value decreased by 100−500 times, which was accompanied by clinical improvement. According to the results of the study, it was noted that in the patients with a manifested clinic sign of cholangitis there is a significant decrease in the number of colonizing units on the third day after endoscopic papillosphincterotomy. At the stone stuck in a papilla the choledoch turns into so−called analog of an abscess. The opening of the papilla provides a free passage of the contents of the choledochus (i.e. pus) into the duodenum, so there is an almost instant therapeutic effect. The increase in pressure in the bile ducts in acute cholangitis is influenced by the development of an inflammatory process, which indicates the manifestations of biliary infection. The presented research has a prospective character and needs further development. Key words: cholangitis, biliary infection, intraductal pressure, bile.

Mechanical Jaundice and Bile Duct Stricture Caused by the Migration of Endoclip and Silk Suture Material into the Common Bile Duct

It is quite rare the migration of metal clips and silk suture materials into the common bile duct (CBD) that were used for the closure of cystic duct in conventional or laparoscopic cholecystectomy.The most common cause of postoperative jaundice is unrecognised or overlooked stones in the bile ducts during operation. The authors present four patients who developed jaundice and in one case biliary tract stricture, caused by the migration of metal clip and silk suture material into CBD following conventional and laparoscopic cholecystectomy. The migration of endoclip and suture material in to CBD is very rare and it should be kept in mind in post-cholecystectomy jaundice. Key Words: Cholecystectomy, Endoclip migration, Mechanical jaundice, Endoscopic retrograde cholangiopancreatography.

Персонифицированная гепатопротекция больных механической желтухой доброкачественного происхождения

Целью исследования явилось изучение эффективности ремаксола у больных механической желтухой неопухолевого происхождения в зависимости от генетических полиморфизмов генов антиоксидантных ферментов. Обследованы 78 пациентов, оперированных по поводу механической желтухи (МЖ) неопухолевого происхождения. Выделены 2 группы: первая (n = 39) — пациентам в раннем послеоперационном периоде проводилось базисное лечение и вторая (n = 39) — в терапию включены и инфузии ремаксола (400 мл). В динамике проведены лабораторные и биохимические исследования: оценивали функциональные показатели печени, интенсивность перекисного окисления мембранных липидов, активность фосфолипазы A2, выраженность гипоксии и др. Также проведен молекулярно-генетический тест полиморфизмов генов супероксиддисмутазы (SOD2, C47T), каталазы (CAT, -262C/T) и глутатион-S-трансферазы (GSTP1, C114T), выделенных из венозной крови при помощи модернизированного метода Laura-Lee Boodram. Анализ генетических локусов произведен с помощью наборов DNA-Extran-1 при использовании полимеразной цепной реакции в реальном времени (CFX96 Touch™ Real-Time PCR Detection System, США). Установлено, что применение ремаксола на раннем периоде развития механической желтухи способствовало ингибированию липопереокисления, фосфолипазной активности, восстановлению функционально-метаболического состояния печени. Результаты генетического исследования показали, что полиморфизмы SOD2, каталазы и GSTP1 играют важную роль не только в прогрессировании патологии, но и эффективности терапии. Оказалось, что в группе пациентов с высокой частотой встречаемости редких генетических маркеров (C/T и T/T составили 28,2 и 33,3 %) полиморфизмов генов антиоксидантных ферментов выраженность оксидативного стресса выше. Об этом свидетельствует повышение содержания диеновых конъюгатов (ДК) на весь период исследования на 24,5 – 33,1 % (p = 0,01), малонового диальдегида (МДА) — на 22,6 – 32,6 % (p = 0,01) и значения индекса гипоксии (ИГ) — на 12,6 – 14,9 % (p = 0,01), активирование фосфолипазы (ФЛ) A2 на 23,6 – 35,6 % (p = 0,01), и ингибирование интенсификации антиоксидантной супероксиддисмутазы (СОД) на 19,8 – 26,5 % (p = 0,01). При этом эффективность ремаксола проявляется в большей степени (интенсивность ДК, МДА и ИГ уменьшалась на 29,6 – 35,6, 28,4 – 38,5 и 22,2 – 26,7 % (p = 0,02), активность ФЛ A2 падала на 39,6 – 42,5 % (p = 0,01), а СОД возрастала на 18,8 – 23,7 % (p = 0,01). Таким образом, результаты исследования являются основанием для своевременного проведения тестов на определение частоты встречаемости патологических генотипов полиморфизмов генов антиоксидантной ферментной системы при МЖ и установление их сопряженности с гомеостатическими показателями, что позволит персонифицировано прогнозировать течение патологии и оценить схему лечения больных механической желтухой.

PROFESSOR IVAN NIKIFOROVICH PIKSIN (to the 85th anniversary of the birth)

The article is dedicated to the 85th birthday of the famous scientist, honored worker of science of the Russian Federation, honored worker of science of the Republic of Mordovia, honored doctor of the Republic of Mordovia, laureate of State prize, head of the scientific-pedagogical surgical school, doctor of medical Sciences professor Piksin Ivan Nikiforovich. I. N. Piksin is the author of fundamental studies of the biomedical effects of quantum radiation at the molecular, cellular and organismal levels in patients with acute destructive diseases of the lungs, purulent-septic diseases, lactational mastitis and other pathologies. The team of the scientific-pedagogical school led by I. N. Piksin explores the problems of diagnosis and treatment of gastroduodenal bleeding, mechanical jaundice, pancreatitis, suppurative diseases of the lung and pleura, surgical diseases of the heart, blood vessels, prevention of complications of limb injuries, diabetes and diabetic foot care, pediatric orthopedics. Under the leadership of I. N. Piksin, new minimally invasive technologies have introduced: transthoracic drainage and rehabilitation therapy of purulent cavities of the lung and pleura, percutaneous and transhepatic cholecystocholangiography, diagnostic and treatment interventions in space-occupying lesions of the abdomen and thyroid gland, ultrasound techniques of diabetes in acute destructive pancreatitis and others. He is considered as one of organizers of higher medical education system in the region. The professor is actively working on improvement in training of medical and scientific personnel for various regions of the Russian Federation.

Therapeutic tactics in cholelithiasis in children

There are still many questions concerning the choice of tactics for the treatment of cholelithiasis in childhood. For a long time, cholelithiasis traditionally considered a pathology of adults. Accordingly, virtually all research was devoted to the diagnosis and treatment of this pathology in the above group of patients.
 Purpose of research. Justification of tactics in surgical treatment of cholelithiasis in children.
 Patients and research methods. The work formed observations on 135 children aged from 2 to 17 years with cholelithiasis. In 70.4% of cases the disease is observed in girls and boys, respectively at 29.6%. 7.8% of patients have children disease arose against the backdrop of hemolytic anemia. One patient, who received urgent indications, had manifestations of mechanical jaundice: an increase in the level of common bilirubin and its direct fraction, pronounced jaundice of the skin. In the second group, 140 children with chronic stoneless cholecystitis were compared.
 Research result. All patients with cholelithiasis identified different ways deformation in the area of gallbladder duct. One of the major causes of cholelithiasis in children are changes in the gallbladder duct. No patient has ever been found in concretions extrahepatic biliary passages. In patients with chronic stone-free cholecystitis pathology in the area of bladder flow was not found.
 Conclusion. One of the major causes of gallstone disease in children are changes in the gallbladder duct, that most likely leads to obstruction of outflow of bile from the gall bladder, with the subsequent formation of concrements. Therefore, the conduct of conservative treatment of cholelithiasis in children appear to be ineffective and the method of choice in the treatment of this pathology can be a cholecystectomy.

Lipid peroxidation, antioxidant defense parameters, and dynamics of surgical treatment in men with mechanical jaundice of various origins

Mechanical jaundice is a severe pathological condition caused by obstruction of the bile duct, usually requiring surgical intervention. Mechanical jaundice occurs in 45–50% of all cases of jaundice of all types, and may be of either non-tumor or tumor origin. Due to involvement of oxidative stress reactions in mechanical jaundice pathogenesis, it is relevant to study the parameters of this process. This study assesses lipid peroxidation-antioxidant defense components in men with mechanical jaundice of non-tumor and tumor origin in the context of surgical treatment. This study examined 47 men with mechanical jaundice of non-tumor origin (MJNT) and 45 men with mechanical jaundice of tumor origin (MJT) (stages I-II of the tumor process). Data from 100 healthy men served as the control. High activity of lipid peroxidation accompanied by falling concentrations of antioxidant enzymes were observed in men with MJNT. Increased primary and final lipid peroxidation products and decreases in almost all studied components of the antioxidant defense system (superoxide dismutase, glutathioneS-transferase, glutathione peroxidase, and ceruloplasmin) were observed. Similar observations emerged for patients with MJT, but with greater changes in parameters. The only indicator of difference between the groups was ceruloplasmin, with lower values in the MJT group. The MJNT group showed decreased thiobarbituric acid reactant values, catalase and ceruloplasmin both values were increased post-surgery. The post-surgery MJT group showed decreased conjugated dienes values and increased catalase and ceruloplasmin values. Thus, in MJNT patients, changes in the lipid peroxidation system relate to the stage of final products, which may serve as a favorable sign, in contrast to the MJT group, where changes concern only the stage of primary products. Based on the data obtained, antioxidant drugs are advised for patients with mechanical jaundice, with special attention given to the tumor origin of the disease.

Механическая желтуха как мультидисциплинарная проблема. Клинический случай

Механическая желтуха как мультидисциплинарная проблема. Клинический случай

Tactics of management of patients with complications of bile disease, manifested by mechanical jaundice depending on stages of its development

Tactics of management of patients with complications of bile disease, manifested by mechanical jaundice depending on stages of its development

Endoscopic ultrasonography in the differential diagnosis of biliopancreatoduodenal tumors

Objective . Todeterminethe role ofendoscopicultrasonography in preoperative differentialdiagnosis of bilio pancreatoduodenal tumorsand choice of further treatment strategy. Material and methods . A retrospective analysis included medical records of 89 patients hospital-ized with suspected biliopancreatoduodenal tumor.Pancreatic head tumor was diagnosed in 41(46.1%) patients, tumorof major duodenal papilla – in 15 patients (16.9%), tumor of distal seg-ment of common bile duct – in 10 patients (11.2%), cicatricial and inflammatory strictures of distal segment of common bile duct – in 19 patients (21.3%), post-necroticpseudocysts of pancreatic head – in 4 patients (4.5%). Results . Sensitivity ofendoscopic ultrasonography for tumors of pancreatic head, major duodenal papilla, distal common bile duct, cicatricial and inflammatory strictures of distal segment of com-mon bile duct and postnecroticpseudocysts of pancreatic head was 90.2%, 100%, 80%, 94.7% and 100%, respectively. Specificity was 97.9%, 94.6%, 98.7%, 98.6% and 100%, respectively. Overall accuracy was 94.4%, 95.5%, 96.6%, 97.8% and 100%, respectively. False-negative results were obtained in 7 cases. Tumor was not excluded in these patients, but there was a conclusion about an-other primary source of growth. Conclusion . Endoscopic ultrasonography is associated with high accuracy of preoperative differen-tial diagnosis of malignant and benign biliopancreatoduodenaltumors and useful to clarify diagnosis in patients with mechanical jaundice syndrome. These data are usedas an objective criterion to de-termine further treatment strategy depending on the results of endoscopic ultrasonography.