Unusual Cause Of Obstructive Jaundice Research Articles

An unusual cause of obstructive jaundice, abdominal pain, and weight loss

A 71-year-old female patient presented to the emergency department after having developed generalized icterus for one week, associated with inappetence due to epigastric pain with a recent weight loss of 15 kg

Giant choledochal cyst. An unusual cause of obstructive jaundice in an adult

Giant choledochal cyst. An unusual cause of obstructive jaundice in an adult

An unusual cause of obstructive jaundice in a 2-year-old child

Background and Objectives:Pancreaticobiliary ascariasis is common problem in tropical countries. The roundworm in the bile duct can cause biliary colic, obstructive jaundice, or pancreatitis. Live Ascaris worms are usually diagnosed on ultrasonography (USG) or endoscopic ultrasonographic (EUS) showing characteristic features of linear mobile echogenic structure with central anechoic lumen. However, the worm can die inside the common bile duct (CBD) and create a foreign body acting as a nidus for stone or sludge formation. Obstructive jaundice due to dead Ascaris is a rare but important cause in the developing World. As the worm shrivels up after death, accurate identification requires a high index of suspicion. The features of dead worm on EUS include hyperechoic structure without any acoustic shadow.Methods:We present a case of a 2-year-old Indian female child referred with biliary colic and jaundice for the last 3 weeks. Abdominal USG revealed multiple ill-defined, oval, hyperechoic shadows near the lower end of dilated CBD. MRCP showed multiple intraluminal curvilinear, hypointense areas in lower CBD.Results:Linear EUS from the duodenal bulb revealed dilated CBD with multiple hyperechoic structures without acoustic shadowing. It showed 2–6 mm sized curvilinear, disc-shaped, short-segment echogenic structures with central anechoic core parallel and equidistant from each other, suggestive of recently broken down parallel fragments of round worms. The central anechoic core represents the digestive tract of Ascaris. After multiple balloon sweeps on ERCP, creamy white structures and yellow-colored material were removed suggestive of recently fragmented Ascaris.Conclusions:Biliary ascariasis should be considered in any child presenting with obstructive jaundice in endemic regions.

Unusual cause of obstructive jaundice revealed by endoscopic ultrasound guided fine-needle aspiration of mediastinal lymph node.

A 65-year-old male presented to us with jaundice of 2-month duration. His liver function tests were suggestive of cholestatic jaundice with serum bilirubin of 28 mg/dL. Ultrasound of the abdomen revealed dilated intrahepatic biliary radicles with a suspicion of intra-ductal mass lesion at the hilum. Contrast-enhanced computed tomography (CT) and magnetic resonance cholangiopancreatography of the abdomen showed a soft tissue lesion in the common bile duct (CBD) extending into the right ductal system as well as distal bile duct with bilobar biliary radical dilatation [Figures 1 and 2 respectively]. Positron emission tomography CT detected a non-fl ourodeoxyglucose (non-FDG) avid mass in the bile duct along with a moderately FDG avid (SUV

An unusual cause of obstructive jaundice due to a bullet impacted in the common bile duct

An unusual cause of obstructive jaundice due to a bullet impacted in the common bile duct

An unusual cause of obstructive jaundice in pregnancy

We present a unique case of jaundice in pregnancy, secondary to common bile duct obstruction by an unusual internal colonic hernia. We also illustrate the benefits of using non-ionizing imaging modalities in the diagnosis and pre-operative planning of this rare condition.

An unusual cause of obstructive jaundice; computed tomography and ultrasound findings of duodenal non-Hodgkin's lymphoma

In children, non-Hodgkin's lymphoma (NHL) is an uncommon cause of obstructive jaundice [Watanabe Y, Ito T, Horibe K, et al. Obstructive jaundice, an unusual initial manifestation of intraabdominal non-Hodgkin's lymphoma in children: complications of percutaneous transhepatic cholangial drainage. J Pediatr Surg 1997;32(4):650–3; Pietsch JB, Shankar S, Ford C, Johnson JE. Obstructive jaundice secondary to lymphoma in childhood. J Pediatr Surg 2001;36(12):1792–5; Ravindra K, Stringer M, Prasad K, Kinsey S, Lodge J. Non-Hodgkin's lymphoma presenting with obstructive jaundice. Br J Surg 2003;90:845–9; Hsu CF, Ko SF, Hsiao CC, Shieh CS, Huang CC, Huang FC. Obstructive jaundice as the presenting manifestation of Burkitt's lymphoma in a 4-year-old boy. J Formos Med Assoc 2003;102(2):105–8], which is usually a late manifestation of NHL [Hsu CF, Ko SF, Hsiao CC, Shieh CS, Huang CC, Huang FC. Obstructive jaundice as the presenting manifestation of Burkitt's lymphoma in a 4-year-old boy. J Formos Med Assoc 2003;102(2):105–8]. Rarely, the primary symptom of NHL is obstructive jaundice caused by pancreaticobiliary obstruction from an abdominal mass [Watanabe Y, Ito T, Horibe K, et al. Obstructive jaundice, an unusual initial manifestation of intraabdominal non-Hodgkin's lymphoma in children: complications of percutaneous transhepatic cholangial drainage. J Pediatr Surg 1997;32(4):650–3; Pietsch JB, Shankar S, Ford C, Johnson JE. Obstructive jaundice secondary to lymphoma in childhood. J Pediatr Surg 2001;36(12):1792–5; Colebath JH. Tumors of liver and bile ducts. In: Jones PG, Campbell PE, editors. Tumors of infancy and childhood. Oxford: New York, NY; 1976. p. 596–626]. Usually enlarged hilar or peripancreatic lymph nodes cause such obstructions [Ravindra K, Stringer M, Prasad K, Kinsey S, Lodge J. Non-Hodgkin's lymphoma presenting with obstructive jaundice. Br J Surg 2003;90:845–9]. There are very few reports of pancreaticobiliary obstruction caused by NHL of the small intestine and duodenum [Pietsch JB, Shankar S, Ford C, Johnson JE. Obstructive jaundice secondary to lymphoma in childhood. J Pediatr Surg 2001;36(12):1792–5]. In this report, we describe obstructive jaundice resulting from the external compression of the pancreaticobiliary duct caused by duodenal NHL in a 4-year-old girl.

Hemobilia: a rare complication after routine liver biopsy during gastric bypass

Hemobilia is an unusual cause of obstructive jaundice. Trauma and iatrogenic injuries are common causes of hemobilia. Because of the high incidence of liver pathologicfindings in morbidly obese patients, many investigators have suggested routine liver biopsies of all patients undergoing bariatric surgery [1‐3]. Considering the low complication rate from liver biopsy and the high incidence of abnormal findings, we have routinely performed liver biopsies in all our patients. We report a case of obstructive jaundice and hemobilia in the immediate postoperative period after laparoscopic gastric bypass secondary to complications from a liver biopsy.

Unusual Case of Obstructive Jaundice in Elderly Patient

In elderly patents the commonest causes of obstructive jaundice are choledocholithiasis and pancreatic and biliary causes. Here we present an unusual cause of obstructive jaundice. Case: 65 year old male patient presented with 3 weeks of jaundice and progressive right upper quadrant pain. Patient denied any fever or weight of loss. Social history was significant for heavy alcohol use and tobacco smoking. Physical examination reflected only deep icterus and mild epigastric tenderness. Lab findings revealed obstructive jaundice with total bilirubin 17.7 mg/dl, direct bilirubin 16.8 mg/dl and WBC count of 16000 mm3. Imaging studies done at an outside hospital which showed biliary dilatation with common bile duct of 15 mm. No pancreatic or hilar mass was identified. ERCP which revealed lot of edema proximal to the ampulla of Vater with ulceration of the duodenum. This ulcerated area was biopsied. Examination of the ampulla revealed a large ampulla with a compressed and pushed down papillary orifice. Free deep cannulation of the bile duct could not be achieved, though on opacifaction smooth narrowing of the common bile duct was visualized. Cytology could not be succesfully obtained. Considering above findings repeat imaging including magenetic resonant cholangiopancreatogram (MRCP) and spiral computed tomography (CT) were done. MRCP reflected the findings on ERCP but showed no mass lesion in the pancreas or peripancreatic area. Spiral CT showed findings of a soft tissue fullness in the periampullary area. Serum CA 19–9 was minimally elevated with a normal CEA. Biopsies from the duodenal ulcer surprisingly reflected squamous cell carcinoma (SCC). Further extensive investigations including magnetic resonant imaging and CT imaging of the lungs, head and neck failed to reveal the primary site. Exploratory laprotomy was done which showed a peripancreatic mass along with jejunal and ileal metastasis. A Roux-en-Y choledochojejunostomy and gastrojejunostomy was done. Histology from surgical specimens reflected SCC.Paient is presently followed by oncology service. Discussion: A wide variety of neoplastic lesions may involve the ampulla of Vater, but SCC is very rare at this location. Tobacco smoking may be considered as risk factor for the SCC of the ampulla of Vater. The management of these patients involves the extensive workup to rule out any other synchronous lesions and the involvement of the surgical team.

Obstructive jaundice secondary to lymphoma in childhood

In children, biliary obstruction secondary to lymphoma is rare. Previous reports in adults and children suggest that these lymphomas are associated with a poor prognosis. The authors reviewed the medical records and imaging studies of 4 children treated for pancreaticobiliary lymphoma at our children's hospital over the past 10 years. All 4 presented with jaundice. Abdominal ultrasound scan and computed tomography (CT) scans were helpful in defining the anatomy of the obstruction. In the cases of involvement of the porta hepatis, the diagnosis was made by biopsy. In one child a mass was in the head of the pancreas, and evaluation of frozen section biopsy results were not diagnostic for lymphoma, and a major resection was performed. All the lymphomas were of nonHodgkin's B-cell type and one was a Burkitt's lymphoma. All responded promptly to chemotherapy. One child had a testicular relapse and currently is receiving additional therapy. Pancreaticobiliary lymphomas are an unusual cause of obstructive jaundice in children. Biopsy alone without resection or biliary drainage is recommended surgical therapy. Long-term survival rate in children with this disorder appears to be more promising than previously reported. J Pediatr Surg 36:1792-1795. Copyright © 2001 by W.B. Saunders Company.

Gallbladder carcinoma with a tumor thrombus in the common bile duct: An unusual cause of obstructive jaundice

A 47-year-old man was admitted to our hospital complaining of epigastralgia and jaundice that had been present for 7 days. Laboratory tests revealed elevated levels of serum total bilirubin (13.5 mg/dL; normal, 0.3-1.3), alkaline phosphatase (871 U/L; normal, 60-201), and carbohydrate antigen 19-9 (CA19-9) (460 U/mL; normal, 0-37). Imaging modalities showed a tumor of the gallbladder with intrahepatic bile duct dilatation. Subsequently, percutaneous transhepatic biliary drainage was carried out: Cholangiography showed a filling defect in the common bile duct with no irregularity of the wall (Figure).

Mirizzi's syndrome. Diagnostic and therapeutic controversies in the laparoscopic era.

Mirizzi's syndrome (MS) is an unusual cause of obstructive jaundice. It can mimic bile duct cancer, and the role of laparoscopic surgery is not well defined. The aim of this paper is to report five cases and describe the pitfalls encountered in its diagnosis and treatment with a laparoscopic approach. From January 1992 to January 1996, five cases of MS out of 560 patients with gallstones prospectively treated and recorded were found (0.9%). There were two men and three women, (mean age: 54 years [30-93]). In one case diagnosis of bile duct carcinoma was established but surgery revealed MS. Four cases were approached by laparoscopy, but all of them were converted: in two, due to a distorted anatomy, in a third due in the difficulty of visualizing the distal end of the bile duct, and in the last case due to the impossibility of retrieving the stones. All were treated with a cholecochorrhaphy over a T tube, except one, in which a hepaticojejunostomy was performed. Morbidity and mortality were nil, and they remain asymptomatic after a mean follow-up of 19 months (3-36). MS constitutes an important laparoscopic challenge, both to clearance of duct stones and to the proper reconstruction of the biliary duct. A prudent policy is to perform a dissection trial and convert if local conditions are not clear for an experienced laparoscopic surgeon.

An unusual cause of obstructive jaundice

An unusual cause of obstructive jaundice

An unusual cause of obstructive jaundice

An unusual cause of obstructive jaundice

Unusual cause of obstructive jaundice.

Unusual cause of obstructive jaundice.D Stallard and M SundaramAudio Available | Share

Extrahepatic Biliary Obstruction by Lymphoma

Extrinsic compression of the common bile duct by enlarged lymph nodes is an unusual cause of obstructive jaundice. We describe two patients with such a manifestation of lymphoma and the use of endoscopic retrograde cholangiopancreatography in distinguishing this rare complication from other causes of jaundice in lymphoma. Patients may have rapid resolution of both symptoms and biochemical abnormalities by nonoperative biliary bypass combined with chemotherapy and/or radiotherapy. Lymphomatous obstruction should be considered a cause of potentially treatable jaundice in patients with known lymphoma; endoscopic retrograde cholangiopancreatography can be valuable as a diagnostic and therapeutic tool.

Obstructive jaundice Unusual complication of postoperative pararenal pseudocyst

An unusual cause of obstructive jaundice, postoperative pararenal pseudocyst formation, has been presented. The pertinent literature has been briefly reviewed, and the factors possibly responsible for the unusual presentation in this case have been discussed.