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A Cause of Intermittent Biliary Obstruction

Joel J. Roslyn, MD; Stephen Kuchenbecker, MD; William P. Longmire, Jr, MD; Ronald K. Tompkins, MD

Arch Surg. 1984;119(11):1312-1315.

Abstract
• Tumor debris, free-floating in the major biliary ductal system, is a cause of intermittent biliary obstruction that has previously not been recognized. Six patients had hepatic neoplasms with episodic jaundice and/or cholangitis due to floating tumor debris. Diagnosis included metastatic adenocarcinoma of the colon (n=3), cholangiocarcinoma (n=1), hepatocellular carcinoma (n=1), and cavernous hemangioma (n=1). All patients underwent biliary exploration, with hepatic resection and transhepatic intubation in two and T-tube placement in four. One patient died in the early postoperative period, and the major complication rate in the five survivors was 0%. Four of the five survivors had no further episodes suggestive of major bile duct obstruction. Our experience emphasizes the importance of distinguishing extrahepatic obstruction secondary to tumor debris from the more common causes of jaundice in patients with tumors and suggests that safe and effective palliation can be achieved in these patients.

(Arch Surg 1984;119:1312-1315)

Author Affiliations
From the Division of General Surgery, UCLA School of Medicine, Los Angeles.

Footnotes
Accepted for publication June 18, 1984.

Read before the Annual Meeting of the Southern California Chapter of the American College of Surgeons, Santa Barbara, Calif, Jan 29, 1984.

Reprint requests to Division of General Surgery, UCLA School of Medicine, Los Angeles, CA 90024 (Dr Roslyn).