Malignant Biliary Obstruction

DEBATE
Stent vs Bypass

JDW 2018
 Proximal
Obstruction

Distal
Obstruction
 causes

Surg Clin North Am. 1996 Feb;76(1):63-70.

#1
#2. Male, 67 yo, Obstructive Jaundice

IMT : 24.08 kg/m2

Karnofsky score : 100
SGA: B

Total Bilirubin Bilirubin T/D/I

21.57/17.51/4.06
 Anamnesis
Chief Complain :
- Icterik since 1,5 month

History of present illness

- Decrease BW 10 kg for 1 Mo
- White Fecal +
 Bilirubin T/D/I

5/9/2018 20.30/15.48/4.82

Alkali Phospat 253

Gamma GT 274

CEA / CA 19-9 9.15 / 783

AFP 15.38
Imaging recommendation ?
 MRI Abdomen
August 25, 2018
CT Scan Abdomen
August 30,2018
ERCP 07/09/2018
 PA 6/09/2018
- Sedian citologi cairan CBD
mengandung sel-sel tumor
epithelial yang tersusun
berkelompok dan tersebar
individual. Sel tumor berinti
pleomorfik, kromatin kasar, anak
inti nyata, membrane sel inti
ireguler, sitoplasma sebagian
bervakuola. Mitosis dapat
ditemukan:
- Kesimpulan: positif
adenokarsinoma
#2. Male, 61 yo, Obstructive Jaundice

IMT : 18.96 kg/m2

Karnofsky score : 90
SGA: B

Total Bilirubin Bilirubin T/D/I

21.57/17.51/4.06
 Anamnesis
Chief Complain :
- Icterik since 1 month

History of present illness

- Decrease BW 10 kg for 1 Mo
- White Fecal +
 Hasil Laboratorium

Pemeriksaan Hasil (23/8/18)

Fosfatase 400 / 584

Alkali/Gamma GT Pemeriksaan Hasil (14/9/18)
PT/APTT 1x/1x

SGOT/SGPT 53/39
DPL 10.0/28.4/17270/57
Ur/Cr 37/1.1 0000
Bilirubin T/D/I 21.57/17.51/4.06
HBeAg / Anti HCV 0.360 (Non-reaktif)
/ 0.070 (Non-
reaktif)
Bilirubin T/D/I 21.51/17.703/3.81

Protein A/G/T 4.34/3.86/8.2

 Abdomen US
August 31, 2018

• Dilatation of IHBD

• Dilatation of CBD

• Sugestive sirosis hepatis

dd/ chronic iver disease

• Mass at GB

• dd/ cholelithiasis et
choledocolithiasis
Imaging recommendation ?
 MRI Abdomen Atas +
MRCP Kontras
01/09/2018

• Massa distal CBD yang

menyebabkan dilatasi
dari ductus CBD
proksimal hingga
intrahepatic kiri-kanan
serta pankreatikus dd/
cholangiocarcinoma

• Kolesistitis dengan
sludge intralumen KE
Recommendation ?
 PTBD
September 14, 2018
Terima Kasih