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DOI: 10.1055/s-2006-947669
Obstructive Jaundice: Dilated CBD, Normal PD, No stones – What then?
Objective: To analyze the aetiology of disease in patients with obstructive jaundice who present with an obstructed distal common bile duct (CBD) but normal caliber pancreatic duct (PD) but with no evidence of choledocholithiasis.
Method: The records of all patients who had endoscopic ultrasound (EUS) performed for obstructive jaundice from March 2003 to May 2005 were reviewed. Patients who had distal CBD obstruction with normal caliber PD and no evidence of choledocholithiasis were studied further. Only patients who had similar ductal findings on computed tomography (CT) scans were included. Patients who did not go for surgery subsequently were excluded. Surgical findings and histopathology results were reviewed to establish the final diagnosis.
Results: A total of 365 EUS procedures were performed for obstructive jaundice during the study period. 15 patients fulfilled all the inclusion criteria. Table 1 shows the final diagnosis of patients after surgery was performed and the histopathology reviewed. CT was able to provide an accurate preoperative diagnosis in 8 patients (53.3%) whereas EUS was accurate in 14 patients (93.3%).
Discussion: It is generally accepted that patients with obstructive jaundice who have ampullary or pancreatic head carcinomas have dilated biliary and pancreatic ductal systems. In our series, we found 10 patients who had these lesions but with a normal caliber PD on imaging. We postulate that these patients probably had lesions in the vicinity of the accessory pancreatic duct without involving the main pancreatic duct. EUS was much more accurate when compared to CT for providing an accurate preoperative diagnosis in this group of patients. The classical 'double-duct' sign is not always present in patients with ampullary or pancreatic head carcinomas.
|
Final |
Diagnosis |
No of pts |
CT accurat |
EUS accura |
|
Ampullary |
Carcinoma |
5 |
2 pts |
5 pts |
|
Distal |
Cholangio |
2 |
1 pt |
1 pt |
|
Pancreatic |
Head |
5 |
4 pts |
5 pts |
|
Neuroendo |
tumour |
1 |
2 pts |
2 pts |
|
Chronic |
Panc |
2 |
1 pt |
2 pts |