Facts and fallacies of common bile duct obstruction by pancreatic pseudocysts

Although it is commonly accepted that pancreatic pseudocysts can cause obstruction of the common bile duct, few documented examples of this phenomenon exist. Most cases of obstructive jaundice associated with pseudocysts appear to be due to fibrotic stricture of the intrapancreatic portion of the common bile duct, rather than to pressure on the duct by the pseudocyst. We report three additional cases, in two of which fibrosis and not the pseudocyst caused the biliary obstruction. This experience illustrates the imperative to perform intraoperative cholangiography after drainage of the pseudocyst and the necessity of a biliary-enteric bypass if bile duct obstruction has not been relieved by simple decompression of the pseudocyst.