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Mechanical jaundice

Mechanical jaundice (MJ)is a complex of symptoms caused by a violation of the outflow of bile into the duodenum. The reasons for this can be both malignant and benign diseases. Malignant diseases include: cancer of the head of the pancreas, a tumor lesion of the walls of the bile ducts at various levels (including a Klatskin tumor), gallbladder cancer, a tumor of the duodenum 12 and the large papilla of the duodenum 12 (papillae), liver tumors (hepatocellular cancer, cholangiocarcinoma or liver metastases), metastatically altered lymph nodes located along the common bile duct. Of the benign causes, the most common cause of MJ is choledocholithiasis, less often-scars and adhesions after surgery on the gallbladder or bile ducts (cicatricial stricture), adenoma of the large papilla of the duodenum, chronic pancreatitis.

The main external manifestations of MJ: jaundice staining of the skin and sclera, itching, darkening of urine, discoloration of feces (feces become gray). If at least one of these signs appears, you should immediately consult a doctor.

In the study of biochemical blood analysis, there is an increase in the level of bilirubin, alkaline phosphatase, and to a lesser extent – liver enzymes.

The main methods of instrumental diagnosis of MJ: ultrasound (ultrasound), multispiral computed tomography (MSCT), magnetic resonance imaging and cholangiography (MRI and MR-HCG).

The long-term existence of MJ inevitably leads to the development of hepatic-renal failure. Therefore, regardless of the causes of MJ, the main therapeutic surgical manipulations are aimed at removing bile from the liver (decompression of the bile ducts). Modern surgery involves the use of only minimally traumatic methods for this: endoscopic (retrograde-from the lumen of the duodenum 12) and percutaneous transhepatic (antegrade – access to the ducts is carried out by piercing the skin and liver parenchyma under the control of ultrasound). Both types of interventions are associated with the use of X-ray control, which allows you to clarify the condition of the bile ducts and to discharge them with greater accuracy.

These interventions can often be the final stage of treatment. For example, in choledocholithiasis - removal of concretions from the lumen of the bile ducts, in inoperable tumors-endobiliary stenting of the bile ducts, in cicatricial strictures-balloon dilation and drainage of the bile ducts with replaceable drains or plastic stents. In other situations, drainage of the bile ducts is the stage of preparation of the patient for radical surgery.

The choice of the method of drainage of the bile ducts depends on the specific clinical situation, the degree of equipment and the level of training of the relevant specialists in the medical institution. In complex cases, it is possible to use both methods simultaneously – the so-called "rendezvous" technique, which significantly increases the capabilities of the methods.

MCSC is one of the few medical institutions where both areas of minimally invasive surgery are equally well developed, at a high professional level, which allows us to successfully provide qualified surgical care even in the most difficult cases.


GBUZ Moscow Clinical Scientific Center named after Loginov MHD