[Obstructive jaundice after surgery of the biliary tract, a benign stricture or not?].
Obstructive jaundice occurred in 3 patients, 2 women, aged 44 and 60 years, and one man aged 62 years: 17 years after choledochojejunostomy following a complicated cholecystectomy, 8 years after hepatojejunostomy following choledochal cyst removal, and 1 year after laparoscopic cholecystectomy. Percutaneous or endoscopic stent placement was performed in all patients to relieve biliary obstruction. However, stent dysfunction repeatedly resulted in re-stenting of the obstruction. Imaging techniques, as well as endoscopic brush pathology could not distinguish between a benign or malignant stenosis. Explorative laparotomy showed a new growth in all 3 patients, of which 2 were malignant. When obstructive jaundice occurs after surgery of the biliary tract for benign disease, the most likely cause is a benign stenosis. Percutaneous or endoscopic stenting is the treatment of choice. In case of unexpected and/or repeated stent failure, when a diagnosis cannot be made due to inconclusive imaging or pathology of the stenosis exploratory surgery should be considered, as malignant stenosis may be present.
Meylaerts
S A
SA
Afd. Chirurgie, Academisch Medisch Centrum/Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam.
van Gulik
T M
TM
Rauws
E A
EA
Gouma
D J
DJ
D000328:Adult; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects*; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D015607:Stents