Extrahepatic biliary tract obstruction secondary to a hepatoma-containing blood clot in the common bile duct

Brand, Stanley N.; Brandt, Lawrence J.; Sprayregan, Seymour; Brenner, Steven E.; Bernstein, Leslie H.

doi:10.1007/bf01072086

Cited by 26 publications

(5 citation statements)

References 22 publications

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“…In patients with an HCC rupture into the biliary tract, blood clots are inevitably mixed with fleshy tumor debris. [10][11][12][13][14] Our patient had previously undergone left hepatectomy for HCC. We therefore suspected recurrent HCC during the choledochotomy; however, no HCC was detected by either macroscopic or intraoperative ultrasonographic examination.…”

Section: Discussionmentioning

confidence: 99%

Common bile duct blood clot: an unusual cause of ductal filling defects for calculi

Shimoji

Shiraishi

Hiroyasu

et al. 1999

Journal of Gastroenterology

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We report a case of obstructive jaundice caused by a blood clot in the common bile duct in a 75-year-old man with cirrhosis. Five years prior to his admission, he had undergone a left hepatectomy for hepatocellular carcinoma. At the present admission, he appeared icteric, and endoscopic retrograde cholangiography revealed filling defects in the common bile duct. Choledochotomy was therefore performed for possible common duct stones, and exploration of the duct showed blood clot casts filling the duct. The casts were easily removed, and the patient's postoperative course was uneventful. However, he developed ascites and jaundice 1 month later and died of liver failure approximately 3 months after undergoing the choledochotomy. Autopsy revealed hemorrhagic necrosis in the proximal intrahepatic duct of the posterior segment, which was considered to be the cause of the observed hemobilia, as well as the blood clot in the common bile duct at surgery. We report this rare case and discuss the cause of hemobilia.

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Section: Discussionmentioning

confidence: 99%

Common bile duct blood clot: an unusual cause of ductal filling defects for calculi

Shimoji

Shiraishi

Hiroyasu

et al. 1999

Journal of Gastroenterology

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“…Obstructive icteric type HCC is rarer but prompt intervention in the appropriate patients in the form of palliative drainage of the obstructed system or surgical resection can lead to prolonged survival and potentially cure [6,7,[9][10][11][12][13][21][22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Cholangiographic Features in the Diagnosisand Management of Obstructive IctericType Hepatocellular Carcinoma

et al. 1998

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In 11 years and 3 months, 2037 patients with HCC were seen and 48 patients (2.4%) were diagnosed to have obstructive icteric type HCC. Five patients were terminally ill and were not investigated further. Forty three patients were initially investigated by endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiogram (PTC) and classified as having obstructive icteric type 1, 2, or 3 HCC based on the cholangiographic findings. The obstruction in type 1 HCC was due to intraluminal tumour casts and/or tumour fragments obstructing the hepatic ductal confluence or common bile duct, while intraluminal blood clots, from haemobilia, filling the biliary tree was the cause in type 2 HCC. The pathology in type 3 HCC was extraluminal obstruction by extensive tumour encasement of the intra–hepatic biliary ductal system and/or extrinsic compression of the hepatic and common bile ducts by tumour(s) and/or malignant lymph nodes. At the initial ERC/PTC, 10 patients (5 resected, 50%) had obstructive icteric type 1 and 23 patients (0 resected) had obstructive icteric type 3 HCC. Of the 10 patients initially classified according to cholangiography to have obstructive icteric type 2 HCC, subsequent investigations revealed that 6 patients had type 1 HCC (4 resectable, 67%) and 4 patients had type 3 HCC (0 resectable). The classification of the obstructive icteric type HCC into types 1, 2, and 3, based on the initial cholangiographic appearances has simplified and rationalized our management strategy for this condition.

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“…There have been sporadic reports of proved extra-hepatic biliary obstruction and rarely was the diagnosis made pre-operatively. In all, the obstruction was due to necrotic tissue (Ishikawa et al, 1973), tumour (Elsner and Jauregui, 1972;Kuroyanagi et al, 1977;Afroudakis et al, 1978;Wind and Futterman, 1977), or blood clot (Johns and Zimmerman, 1961;Brand et al, 1976), which had gained entrance to and blocked the extra-hepatic ducts. A characteristic of hepatoma is its ability to undergo necrosis and degeneration.…”

Section: Discussionmentioning

confidence: 99%

Hepatoma and obstructive jaundice

Cleland

Adjukiewicz

1980

Postgraduate Medical Journal

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Extrahepatic biliary tract obstruction secondary to a hepatoma-containing blood clot in the common bile duct

Cited by 26 publications

References 22 publications

Common bile duct blood clot: an unusual cause of ductal filling defects for calculi

Common bile duct blood clot: an unusual cause of ductal filling defects for calculi

Cholangiographic Features in the Diagnosisand Management of Obstructive IctericType Hepatocellular Carcinoma

Hepatoma and obstructive jaundice

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