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In some patients with jaundice, the differentiation between hepatitis with cholestatic features (as induced by infection or drugs) and mechanical extrahepatic obstruction remains notoriously difficult. A correct diagnosis is particularly important because of the hazards attributed to surgical procedures in patients with hepatitis, although the operative risks have never been specified.
Doctors Harville and Summerskill have approached the problems presented by such patients by reviewing the findings in 58 patients who subsequently were found to have hepatitis. These patients underwent laparotomy, usually because jaundice was suspected to be the result of a surgical lesion. As would be expected, the clinical features were equivocal and tests of hepatic function or hepatic biopsies were seldom of assistance as indicators of the correct diagnosis. While pointing out that the decision to perform laparotomy was still the correct one in the majority of their cases, they suggest the desirability of a greater awareness of
SURGERY IN ACUTE HEPATITIS. JAMA. 1963;184(4):307. doi:10.1001/jama.1963.03700170099015
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