Biliary obstruction in chronic XXXX : indications for surgical intervention.

@entity1 @entity2835 @entity788 @entity697 @entity295 @entity1578 @entity490
A syndrome of distal common bile duct obstruction secondary to the fibrotic effects of chronic @entity788 has been recognized for some time. A group of ten characteristic @entity1 , seven of whom have undergone surgery, is discussed. The diagnostic techniques and surgical procedures are presented, and the results are analyzed. Three @entity1 with the syndrome were not operated upon and one improved spontaneously. The typical @entity1 was a male alcoholic, average age 48 years, with a history of chronic, relapsing @entity788 and @entity490 . The most consistently abnormal laboratory value is a markedly elevated alkaline phosphates level. Endoscopic retrograde pancreaticocholangiography and transhepatic cholangiography are the most useful diagnostic procedures. Fifteen per cent of the most useful diagnostic procedures. Fifteen per cent of the @entity1 operated upon required emergent surgery for @entity697 and @entity295 . Another 29 per cent required prompt intervention for progressive @entity1578 secondary to @entity2835 . The authors advocate an aggressive approach to establish biliary drainage in the presence of @entity697 or @entity2835 . If a dilated pancreatic duct can be demonstrated and @entity490 is the principal problem a direct procedure on the pancreas is needed.
