Anwar Sana, Rasool Malik Ali Afaq, Hamza Ali, Shahid Muhammad Salman, Subhan Muhammad, Bibi Ruqiya
Internal Medicine, Lugansk State Medical University, San Antonio, USA.
Medicine, King Edward Medical University, Lahore, PAK.
Cureus. 2024 Jul 15;16(7):e64598. doi: 10.7759/cureus.64598. eCollection 2024 Jul.
Obstructive jaundice occurs when an obstruction in the bile duct system prevents bile from flowing from the liver into the intestine, accumulating bilirubin in the blood. This condition can result from various causes, including gallstones, tumors, or inflammation of the bile ducts. The management of obstructive jaundice depends on the underlying cause (malignant obstructions such as cholangiocarcinoma or pancreatic cancer), indicating the need for surgical intervention. The Whipple procedure (pancreaticoduodenectomy) is the standard curative approach for resectable distal common bile duct (CBD) adenocarcinoma. Doctors usually recommend adjuvant chemotherapy to reduce the risk of recurrence. We report the case of a 70-year-old male with a history of untreated hypertension, type 2 diabetes, and long-term smoking, who presented with classic signs of obstructive jaundice, including yellowing of the eyes, itching, right upper quadrant pain, and intermittent fevers. Laboratory findings revealed elevated inflammatory markers, bilirubin, liver enzymes, and leukocyte count, indicative of an inflammatory and obstructive biliary condition. Imaging studies confirmed a distal CBD stricture, including abdominal ultrasound, computed tomography scans, and endoscopic retrograde cholangiopancreatography (ERCP). Brush cytology obtained during ERCP revealed a well-differentiated adenocarcinoma of the distal CBD. The patient's treatment plan included preoperative optimization, surgical resection via the Whipple procedure, and postoperative adjuvant therapy. This case emphasizes the importance of a thorough diagnostic workup and a multidisciplinary treatment strategy in managing complex cases of obstructive jaundice in the elderly, highlighting the need for personalized care to achieve optimal outcomes.
当胆管系统发生梗阻，阻止胆汁从肝脏流入肠道，导致胆红素在血液中积聚时，就会发生梗阻性黄疸。这种情况可由多种原因引起，包括胆结石、肿瘤或胆管炎症。梗阻性黄疸的治疗取决于潜在病因（如胆管癌或胰腺癌等恶性梗阻），这表明需要进行手术干预。Whipple手术（胰十二指肠切除术）是可切除的远端胆总管腺癌的标准根治方法。医生通常建议进行辅助化疗以降低复发风险。我们报告了一例70岁男性患者，有未治疗的高血压、2型糖尿病病史且长期吸烟，出现了梗阻性黄疸的典型症状，包括眼睛发黄、瘙痒、右上腹疼痛和间歇性发热。实验室检查结果显示炎症标志物、胆红素、肝酶和白细胞计数升高，表明存在炎症性和梗阻性胆道疾病。影像学检查证实了远端胆总管狭窄，包括腹部超声、计算机断层扫描和内镜逆行胰胆管造影（ERCP）。ERCP期间获取的刷检细胞学检查显示远端胆总管为高分化腺癌。患者的治疗方案包括术前优化、通过Whipple手术进行手术切除以及术后辅助治疗。该病例强调了在处理老年患者复杂的梗阻性黄疸病例时进行全面诊断检查和多学科治疗策略的重要性，突出了需要个性化护理以实现最佳治疗效果。
