Extrahepatic biliary obstruction by lymphoma

E. Feller and F. J. Schiffman
Department of Medicine, Miriam Hospital/Brown University, Providence, RI 02906.

Extrinsic compression of the common bile duct by enlarged lymph nodes is an unusual cause of obstructive jaundice. We describe two patients with such a manifestation of lymphoma and the use of endoscopic retrograde cholangiopancreatography in distinguishing this rare complication from other causes of jaundice in lymphoma. Patients may have rapid resolution of both symptoms and biochemical abnormalities by nonoperative biliary bypass combined with chemotherapy and/or radiotherapy. Lymphomatous obstruction should be considered a cause of potentially treatable jaundice in patients with known lymphoma; endoscopic retrograde cholangiopancreatography can be valuable as a diagnostic and therapeutic tool.