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Obstructive Diseases of the Extrahepatic Biliary System |  |
| Obstructive diseases of the extrahepatic biliary system are most often associated with pancreatic disease (see
Pancreatitis: Overview). Pancreatic edema, inflammation, or fibrosis due to pancreatitis can cause compression of the common bile duct. Diagnosis is based on laboratory data (increased AP, bilirubinuria with or without bilirubinemia) and on radiographic and ultrasonographic evidence of pancreatic disease. Medical management of pancreatitis is often the only treatment necessary to relieve biliary obstruction. If this is not successful, then either temporary compression of
the gallbladder with a catheter or cholecystoduodenostomy may be necessary. Choleliths rarely cause obstruction, but when this does occur, cholecystectomy is preferred over choledochectomy (incision of the common bile duct, which can lead to stricture postsurgically). Neoplasia of the pancreas, bile ducts, liver, intestines, and lymph nodes can also cause obstructive disease. Biopsy is needed to confirm the diagnosis. Cholecystojejunostomy may be palliative, but a cure can rarely be
achieved. Other than for lymphoma, chemotherapy is generally not effective. |
