Secondary Multiple Choledocholithiasis in Obstructive Jaundice Patient Due to Choledochoduodenal-Fistula Stricture

Choledochoduodenal fistula (CDF) is an abnormal communication between the common bile duct and the duodenum. It accounts for about 5% to 25% of the total biliary fistulas and is usually due to a perforated duodenal ulcer, choledocholithiasis, and complications secondary to tuberculosis or could be iatrogenic. Primary intrabilliary tumors usually cause obstructive jaundice and rarely biliary metastasis arising from other organs like colon, breast, and lungs can cause obstructive jaundice. There has been a case report of metastasis from ovarian cancer to the major papilla of the duodenum but no reported cases of it causing a CDF. We report a rare case of an 83-year-old female with ovarian cancer who developed a metastatic lesion to the duodenum eventually resulting in a CDF.

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Indications for Surgical Exploration in the Diagnosis of Intrahepatic Obstructive Jaundice

Gastroenterology ◽

10.1016/s0016-5085(19)36343-7 ◽

1952 ◽

Vol 22 (2) ◽

pp. 232-243

Author(s):

Leonard A. Stine ◽

Richard M. Bendix ◽

Jerome M. Swarts

Keyword(s):

Obstructive Jaundice ◽

Surgical Exploration

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Prolonged Severe Obstructive Jaundice in Hodgkin's Disease

Gastroenterology ◽

10.1016/s0016-5085(63)80013-x ◽

1963 ◽

Vol 44 (2) ◽

pp. 199-204 ◽

Cited By ~ 12

Author(s):

Kerrison Juniper

Keyword(s):

Obstructive Jaundice ◽

Hodgkin's Disease ◽

Hodgkin’S Disease

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Obstructive jaundice due to spontaneous duodenal hematoma complicating anticoagulant therapy

Zeitschrift für Gastroenterologie ◽

10.1055/s-0030-1264122 ◽

2010 ◽

Vol 48 (08) ◽

Author(s):

A Abdel Samie ◽

R Sun ◽

U Vöhringer ◽

L Theilmann

Keyword(s):

Obstructive Jaundice ◽

Anticoagulant Therapy ◽

Duodenal Hematoma

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Impaired Fibrinolysis in Obstructive Jaundice - Evidence from Clinical and Experimental Studies

Thrombosis and Haemostasis ◽

10.1055/s-0038-1647628 ◽

1988 ◽

Vol 60 (01) ◽

pp. 025-029 ◽

Cited By ~ 8

Author(s):

M Colucci ◽

D F Altomare ◽

G Chetta ◽

R Triggiani ◽

L G Cavallo ◽

...

Keyword(s):

Renal Failure ◽

Bile Duct ◽

Obstructive Jaundice ◽

Plasminogen Activator ◽

Fibrinolytic Activity ◽

Experimental Studies ◽

Plasminogen Activator Inhibitor ◽

Venous Stasis ◽

Microvascular Thrombosis ◽

Duct Ligation

SummaryMicrovascular thrombosis is considered an important pathogenetic factor in renal failure associated with obstructive jaundice but the mechanisms leading to fibrin deposition are still unknown. The plasma levels of plasminogen activator inhibitor (PAI) in 29 patients with obstructive jaundice were found significantly increased as compared to 20 nonjaundiced patients. Fibrin autography of plasma supplemented with tissue plasminogen activator (t-PA) revealed that in icteric samples most of the added activator migrated with an apparent Mr of 100 kDa, corresponding to t-PA-PAI complex, whereas in control samples virtually all t-PA migrated as free enzyme. PAI activity detected in icteric samples is similar to the endothelial type PAI since it is neutralized by a monoclonal antibody against PAI-1.Venous stasis in jaundiced patients was neither associated with an increase in blood fibrinolytic activity nor with a decrease in PAI activity. Immunologic assay showed that t-PA release was impaired in 3 out of 4 patients. In controls, venous occlusion induced an increase in both fibrinolytic activity and t-PA antigen and a reduction in PAI activity. Bile duct recanalization in jaundiced patients subjected to surgery was accompanied by a decrease in plasma PAI activity which paralleled the decrease in serum bilirubin levels. In nonjaundiced patients, surgical treatment did not cause significant changes in either parameter. Rabbits made icteric by bile duct ligation showed an early and progressive increase in plasma PAI activity indicating that obstructive jaundice itself causes the elevation of circulating PAI. It is concluded that obstructive jaundice is associated with a severe impairment of fibrinolysis which might contribute to microvascular thrombosis and renal failure.

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