PDF(Pubmed)
Abstract：
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.
摘要：
当胆管系统阻塞阻止胆汁从肝脏流入肠道时，就会发生阻塞性黄疸。在血液中积累胆红素.这种情况可能是由各种原因造成的，包括胆结石,肿瘤，或者胆管发炎.梗阻性黄疸的治疗取决于根本原因（恶性梗阻，如胆管癌或胰腺癌），表明需要手术干预。Whipple手术（胰十二指肠切除术）是可切除的远端胆总管（CBD）腺癌的标准治疗方法。医生通常推荐辅助化疗以降低复发风险。我们报告了一名70岁的男性，有未经治疗的高血压病史，2型糖尿病,和长期吸烟，表现出典型的阻塞性黄疸症状，包括眼睛变黄，瘙痒,右上腹疼痛,断断续续的发烧。实验室发现显示炎症标志物升高,胆红素,肝酶，和白细胞计数,指示炎症和阻塞性胆道疾病。影像学研究证实了远端CBD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术（ERCP）。ERCP期间获得的刷细胞学检查显示远端CBD的高分化腺癌。患者的治疗计划包括术前优化,通过Whipple手术切除,术后辅助治疗。该病例强调了彻底的诊断检查和多学科治疗策略在处理老年梗阻性黄疸复杂病例中的重要性。强调个性化护理以达到最佳效果的必要性。
