Treatment of a patient with obstructive jaundice and extrahepatic portal hypertension.
BACKGROUND
Recurrence of inflammation in the extrahepatic bile duct can lead to bile duct stenosis, obstructive jaundice and cavernous transformation of the portal vein. The latter can develop into extrahepatic portal hypertension (PHT). It is difficult to establish the correct method for treating these conditions.


METHODS
At another hospital, a 51-year-old man developed PHT as a result of endoscopic retrograde cholangiopancreatography and endoscopic nasobiliary drainage to relieve cholelithiasis and obstructive jaundice. We dealt with the biliary tract obstruction through percutaneous transhepatic cholangial drainage (PTCD), followed by selective devascularization and a shunt operation 2 weeks after the disappearance of jaundice. Three months after cholecystojejunostomy, there were no obvious changes around the bile duct.


RESULTS
The patient recovered uneventfully and was discharged 14 days after operation.


CONCLUSIONS
For this patient, surgery in stages was the best choice. The most suitable method to decrease jaundice is PTCD.
Xu
Qing
Q
Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Gu
Lei
L
Wu
Zhi-Yong
ZY
D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000009:adverse effects*; D049448:Cholangiopancreatography, Magnetic Resonance; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery*; D003251:Constriction, Pathologic; D004322:Drainage / Q000009:adverse effects*; D006801:Humans; D006975:Hypertension, Portal / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D041781:Jaundice, Obstructive / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D007582:Jejunostomy; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011169:Portal Vein / Q000000981:diagnostic imaging / Q000473:pathology; D011172:Portography; D012086:Reoperation; D013156:Splenectomy