Nov 1, 1978

Extrahepatic biliary obstruction by metastatic colon carcinoma

Annals of Surgery
A L Warshaw, J P Welch


Extrahepatic biliary obstruction can be caused by cancer metastatic from the colon to the lymph nodes adjacent to the bile duct. This report details our experience with eight such cases treated at the Massachusetts General Hospital in the last seven years. The interval between resection of the primary tumor and appearance of jaundice averaged 13 months. The location of the obstruction, preferably defined preoperatively by cholangiography, was low on the common duct in three cases and high in the porta hepatis in five. Relief of biliary obstruction was accomplished by biliary-enteric bypass (four cases), internal biliary stenting by permanent indwelling tube (two cases), or by portal irradiation (two cases). In addition to palliating the symptoms of obstructive jaundice, the period of comfortable survival appears to have been extended: the bypassed patients lived 13-38 months. Erosion of tumor into the duodenum, with resulting gastrointestinal hemorrhage, was an additional problem in three patients. Our overall experience illustrates the value of distinguishing this subgroup of patients from the larger number whose jaundice results from extensive liver metastases, and of treating aggressively those with extrahepatic biliary obst...Continue Reading

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Mentioned in this Paper

Entire Porta Hepatis
Jaundice, Obstructive
Yellow Skin or Eyes (Symptom)
Primary Neoplasm
Malignant Tumor of Colon
Cholestasis, Extrahepatic
Secondary Malignant Neoplasm of Liver
Erosion Lesion

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