Related Experiment Videos
Obstructive jaundice secondary to hepatocellular carcinoma rupture into the common bile duct: choledochoscopic
1Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, ROC.
Background/Aims:
Hepatocellular carcinoma presenting as obstructive jaundice caused by floating tumor debris in the common bile duct is rare. We report choledochoscopic findings in this rare condition.
Methodology:
From January 1981 to December 1995, 28 patients received surgical treatment for obstructive jaundice secondary to hepatocellular carcinoma rupture into the common bile duct. Among them, intra-operative choledochoscopy was performed in 18 patients.
Results:
Choledochoscopic findings revealed tumor thrombus and an intraluminal yellowish nodular mass in all patients, blood clots in the bile duct in 8 patients, and the appearance of acute erythematous cholangitis in 4 patients. Choledochoscopy revealed that the site of hepatoma rupture was from the right intrahepatic duct in 9 patients, from the left hepatic duct in 7 patients, and from the hepatic hilum in 2 patients. Choledochoscopically guided hepatic resection was performed in 4 patients.
Conclusions:
Intra-operative choledochoscopy reveals the characteristic finding of an intraluminal yellowish nodular mass in patients with malignant obstruction of the bile duct due to hepatocellular carcinoma. Hepatic resection with a free margin of the involved hepatic duct can be achieved by a choledochoscopically guided operation.