Obstructive jaundice secondary to hepatocellular carcinoma rupture into the common bile duct: choledochoscopic findings.

BACKGROUND/AIMS: Hepatocellular carcinoma presenting as obstructive jaundice caused by floating tumor debris in the common bile duct is rare. We report choledochoscopic findings in this rare condition.

METHODOLOGY

From January 1981 to December 1995, 28 patients received surgical treatment for obstructive jaundice secondary to hepatocellular carcinoma rupture into the common bile duct. Among them, intra-operative choledochoscopy was performed in 18 patients.

RESULTS

Choledochoscopic findings revealed tumor thrombus and an intraluminal yellowish nodular mass in all patients, blood clots in the bile duct in 8 patients, and the appearance of acute erythematous cholangitis in 4 patients. Choledochoscopy revealed that the site of hepatoma rupture was from the right intrahepatic duct in 9 patients, from the left hepatic duct in 7 patients, and from the hepatic hilum in 2 patients. Choledochoscopically guided hepatic resection was performed in 4 patients.

CONCLUSIONS

Intra-operative choledochoscopy reveals the characteristic finding of an intraluminal yellowish nodular mass in patients with malignant obstruction of the bile duct due to hepatocellular carcinoma. Hepatic resection with a free margin of the involved hepatic duct can be achieved by a choledochoscopically guided operation.