[Skip to Content]
Sign In
Individual Sign In
Create an Account
Institutional Sign In
OpenAthens Shibboleth
[Skip to Content Landing]
Article
November 1984

Floating Tumor DebrisA Cause of Intermittent Biliary Obstruction

Author Affiliations

From the Division of General Surgery, UCLA School of Medicine, Los Angeles.

Arch Surg. 1984;119(11):1312-1315. doi:10.1001/archsurg.1984.01390230078019
Abstract

• Tumor debris, free-floating in the major biliary ductal system, is a cause of intermittent biliary obstruction that has previously not been recognized. Six patients had hepatic neoplasms with episodic jaundice and/or cholangitis due to floating tumor debris. Diagnosis included metastatic adenocarcinoma of the colon (n=3), cholangiocarcinoma (n=1), hepatocellular carcinoma (n=1), and cavernous hemangioma (n=1). All patients underwent biliary exploration, with hepatic resection and transhepatic intubation in two and T-tube placement in four. One patient died in the early postoperative period, and the major complication rate in the five survivors was 0%. Four of the five survivors had no further episodes suggestive of major bile duct obstruction. Our experience emphasizes the importance of distinguishing extrahepatic obstruction secondary to tumor debris from the more common causes of jaundice in patients with tumors and suggests that safe and effective palliation can be achieved in these patients.

(Arch Surg 1984;119:1312-1315)

References
1.
Jaffe BM, Donegan WL, Watson F, et al:  Factors influencing survival in patients with untreated hepatic metastases . Surg Gynecol Obstet 1968;127:1-11.
2.
Warshaw AL, Welch JP:  Extrahepatic biliary obstruction by metastatic colon carcinoma . Ann Surg 1978;188:593-597.Article
3.
Popp JW Jr, Schapiro RH, Warshaw Al:  Extrahepatic biliary obstruction caused by metastatic breast carcinoma . Ann Intern Med 1979;91: 568-571.Article
4.
Engel JJ, Trujillo Y, Spellberg M:  Metastatic carcinoma of the breast: A cause of obstructive jaundice . Gastroenterology 1980;78:132-135.
5.
Temple DF, Parthasarathy KL, Bakshi SI, et al:  A comparison of isotopic and computerized tomographic scanning in the diagnosis of metastasis to the liver in patients with adenocarcinoma of the colon and rectum . Surg Gynecol Obstet 1983;156:205-208.
6.
O'Connor KW, Snodgrass PJ, Swonder JE, et al:  A blinded prospective study comparing four current noninvasive approaches in the differential diagnosis of medical versus surgical jaundice . Gastroenterology 1983;84: 1498-1504.
7.
Matzen P, Malchow-Moller A, Brun B, et al:  Ultrasonography, computed tomography, and cholescintigraphy in suspected obstructive jaundice: A prospective comparative study . Gastroenterology 1983;84:1492-1497.
8.
Mueller PR, Harbin WP, Ferruci JT Jr, et al:  Fine-needle transhepatic cholangiography: Reflections after 450 cases . AJR 1981;136:85-90.Article
9.
Silvis SE, Rohrmann CA, Vennes JA:  Diagnostic accuracy of ERCP in hepatic biliary and pancreatic malignancy . Ann Intern Med 1979;84:438-446.Article
10.
Levine AW, Donegan WL, Irwin M:  Adenocarcinoma of the colon with hepatic metastases: Fifteen-year survival . JAMA 1982;247:2809-2810.Article
11.
McArthur MS, Teergraden DK:  Metastatic melanoma presenting as obstructive jaundice with hemobilia . Am J Surg 1983;145:830-832.Article
12.
Daunt N, King DM:  Metastatic melanoma in the biliary tree . Br J Radiol 1982;55:873-874.Article
13.
Lillicrap DP, Ginsburg AD, Corbett WEN:  Relapse of acute myelogenous leukemia presenting with extrahepatic obstruction of the biliary tract . Can Med Assoc J 1981;127:1000-1001.
14.
Berkowitz D, Gambescia J, Thompson CM:  Jaundice with signs of extra-hepatic obstruction as the presenting symptom of bronchogenic carcinoma . Gastroenterology 1952;20:653-657.
15.
Kojiro M, Kawabata K, Kawano Y, et al:  Hepatocellular carcinoma presenting as intrabile duct tumor growth: A clinicopathologic study of 24 cases . Cancer 1982;49:2144-2147.Article
16.
Tsuzuki T, Ogata Y, Iida S, et al:  Hepatoma with obstructive jaundice due to the migration of a tumor mass in the biliary tract: Report of a successful resection . Surgery 1979;85:593-598.
×