Obstructive jaundice in gastric carcinoma: cause, site, and relationship to the primary lesion

Obstructive jaundice is frequently present in patients with advanced gastric carcinoma. The purpose of this study was to assess the cause and preferential site of bile duct obstruction in patients with gastric carcinoma and to evaluate correlativity of biliary obstruction with the nature of the primary gastric lesion.

Cholangiographic findings of 54 patients with metastatic gastric carcinoma presenting with obstructive jaundice were reviewed retrospectively. The level of the bile duct obstruction was divided into four segments: segment 1, from an individual intrahepatic duct to the biliary hilum; segment 2, common hepatic duct (CHD) involvement from the biliary hilum to the level of the cystic duct; segment 3, the proximal half of the common bile duct (CBD); segment 4, the distal half of the CBD. To evaluate the characteristics of the primary gastric lesion, operative records and pathologic findings were reviewed.

Obstruction sites were segment 1 in eight patients (15%), segment 2 in 25 (46%), segment 3 in 17 (32%), and segment 4 in four (7%). The causes of obstruction were metastatic lymphadenopathy in the hepatoduodenal ligament (50 of 54) and direct invasion of the primary or recurrent tumor (four of 54). The location of the primary gastric lesions was the antrum, antrum and body, and body in 36 (67%), 17 (31%), and 1 (2%), respectively. Borrmann type 3 lesions were present in 72% of cases, and type 2 lesions in the remaining 24%. Histologic type was undifferentiated adenocarcinoma in 91% of patients, and differentiated adenocarcinoma in the remaining. Serosal invasion was shown in 96% of the patients.

Our results show that the cause of bile duct obstruction in advanced gastric carcinoma is predominantly metastatic lymphadenopathy in the hepatoduodenal ligament, and its preferential site is around the level of the cystic duct. Obstructing lesions showed characteristic cholangiographic findings.