Αποφρακτικός ίκτερος από ρήξη πρωτοπαθών νεοπλασμάτων του ήπατος εντός των χοληφόρων οδών

The most common feature of the clinical symptomatology of the malignant prumary liver tumors is the jaundice which appear in progressive stages due to hepatocellular lesion and also to the abstruction of the intrahepatic bile ducts. On the contrary, the early appearance of obstructive jaundice as a result of obstruction in to the biliary tract by masses produced from the fusion of carcinoma caused by rupture of malignant primary liver tumores constitute rare exception. This complication is a direct consequence of tumor invasion in to a branch of the intrahepatic duct system. Subsequently, mechanical obstruction of the main ducts may occur by: First, fragment of necrotic tumor may separate from the, proximal intraductal growth, migrating to the distal common bile duct and there obstructing the system. Second, hemorrhage from the tumor may partially or completely fill the biliary tree with blood clots containing tumor cells. During the period of 1970-1987, there were operated in the B' Surgical unit of the Greek Red Cross Hospital four (4) cases with obstructive jaundice caused by spontaneous rupture of malignant primary liver tumors in to the biliary tract, from these 3 were men and (1) one was a woman. That consists only 0,5% of the 750 cases of obstructive jaundice which were operated in the same period. In the present thesis, these four (4) rare cases are described. There diagnostic and therapeutic problems are analyzed. From what we know in a review of the world-wide literature only few cases are reported. The preoperative diagnosis of the obstructive jaundices caused by rupture of malignant primary liver tumores in to the biliary tract is extremely difficult. The recent widespread use of percutaneous thin-needle transhepatic cholangiography (PTC) in connection with the selective hepatic arteriography and endoscopic retragrade cholangiopancreatography (ERCP) should aid in preoperative diagnosis to the jaundiced patient caused by hepatocellular carcinoma. The prognosis of these patients is grave. Also surgical resections of these carcinomas don't seem to change survival and the palliative treatment drainage using the insertion of T-tube into the bile duct is the only choice available. In conclusion we can say that the main characteristics of this complication are: a) the rarity b) the highest frequency to men c) the preoperative diagnosis is extremely difficult d) the radical treatment is impossible and e) the prognosis is grave. The development of a cholestatic picture in a patient with underlying cirrhosis should alert the physician to the biliary tract complications of hepatocellular carcinoma.

Grantor dc:publisher

National and Kapodistrian University of Athens

Year dc:date

1990

Authors dc:creator

• Sliman, Monther
• Σλήμαν, Μούνδερ

• Αποφρακτικός ίκτερος
• Ηπάτωμα
• Κακοήθες
• Πρωτοπαθή όγκοι ήπατος
• Χοληφόρο δένδρο
• Biliary tract
• Malignant
• Obstructive jaundice
• Primary liver tumors
• Ιατρική και Επιστήμες Υγείας
• Βασική Ιατρική
• Medical and Health Sciences
• Basic Medicine

Language dc:language

gre

Identifier

10.12681/eadd/1645

OAI identifier oai:identifier

oai:10442/1645