Obstructive Jaundice as a Complication of Pancreatitis

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Abstract
Twenty-four chronic alcoholic patients presenting obstructive jaundice proved or presumed to be caused by pancreatitis are reported. In ten patients, common bile duct obstruction by pancreatitis was demonstrated at surgical exploration, autopsy or both. In 14 patients, the diagnosis of transient obstructive jaundice due to pancreatitis was presumptive and based on clinical analysis without anatomical confirmation. The jaundice was considered to be most consistent with reversible extra-hepatic obstruction because of the disproportionately high levels of serum alkaline phosphatase and/or the rapid decline of the levels of serum bilirubin and alkaline phosphatase. The transient obstructive jaundice in these 14 patients could not be attributed to choledocholithiasis, since cholecystography performed after recovery revealed normal gallbladder function without evidence of calculi. There was no history of the ingestion of drugs that are known to produce jaundice. In 11 patients studied by liver biopsy, minimal necrobiosis or necrosis was seen. Three had fatty cirrhosis, and marked cholestasis was seen in 8 biopsy specimens. The diagnosis of pancreatitis in these 14 patients was inferred, after a period of observation, from an analysis of the history, physical findings and supporting laboratory data (amylase levels, transient hyperglycemia, transient hyperlipemia). Four patients in the present series had evidence of hemolysis as well as an obstructive type of jaundice. Two had hyperlipemia and therefore may be considered instances of the "Zieve syndrome." Common bile duct obstruction due to pancreatitis is more frequent than has previously been recognized.