title: Obstructive jaundice caused by neuroblastoma managed with temporary cholecystostomy tube.
abstract: Neuroblastoma presenting as obstructive jaundice is very rare. The authors present two cases of neuroblastoma, one primary and one recurrent, manifesting as a malignant obstruction of the extrahepatic biliary system. Various methods of biliary decompression were considered in these children including transhepatic or retrograde biliary stenting and internal cholecystoenteric bypass. An attempt at percutaneous transhepatic stent placement failed in one case. In each patient, a simple insertion of a cholecystostomy tube proved effective. Immediately postoperatively, both patients had rapid resolution in symptoms and a decrease in bilirubin levels. Transient mild cholangitis in both children was successfully treated with antibiotics. Chemotherapy reduced the tumor size in each case, and the cholecystostomy tubes were removed within 3 weeks, after cholangiography showed patency of the distal common bile ducts. Temporary cholecystostomy tube drainage and systemic chemotherapy proved to be a safe, simple, and effective method for managing obstructive jaundice caused by neuroblastoma in these two cases.
authors.affiliation: Department of Surgery, British Columbia's Children's Hospital, Canada.
authors.forename: K W
authors.initials: KW
authors.lastname: Gow
authors.forename: G K
authors.initials: GK
authors.lastname: Blair
authors.forename: R
authors.initials: R
authors.lastname: Phillips
authors.forename: D
authors.initials: D
authors.lastname: Stringer
authors.forename: J J
authors.initials: JJ
authors.lastname: Murphy
authors.forename: B H
authors.initials: BH
authors.lastname: Cameron
authors.forename: G C
authors.initials: GC
authors.lastname: Fraser
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D001651:Cholestasis, Extrahepatic / Q000209:etiology* / Q000628:therapy*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D007440:Intubation; D008297:Male; D009364:Neoplasm Recurrence, Local; D009447:Neuroblastoma / Q000150:complications* / Q000188:drug therapy; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000188:drug therapy