EFFICIENCY OF INSTRUMENTAL METHODS FOR DIFFERENTIAL DIAGNOSIS OF MECHANICAL JAUNDICE

Aim. The aim of the study was to investigate the efficiency of instrumental methods for differential diagnosis of mechanical jaundice. Materials and methods. Retrospective analysis of the results of mechanical jaundice diagnosis was carried out in 253 patients. Transabdominal ultrasonography (US), endoscopic retrograde cholangiography (ERCG), percutaneous transhepatic cholangiography (PTCG), intraoperative cholangiography (ICG), computed tomography (CT), magnetic resonance imaging (MRI) were used. Results. Calculous character of disease was revealed in 133 (53 %) patients, acalculous mechanical jaundice - in 120 (47 %). Ultrasonography has a sensitivity of 87 % when revealing cholelithiais, 13 % - diagnosis of choledocholithiasis, 43 % - tumors of pancreaticoduodenal zone (PDZ). ERCG is most effective for diagnosis of choledocholithiasis and big duodenal papilla stenosis (sensitivity, 91 % and 78 %, respectively). In case of benign and malignant biliary strictures, the study is also highly informative, but can be performed only in 21 % of cases. CT and MRI demonstrate a high sensitivity (75-100 %); they are most effective when determining the character of pathological process. PTCG sensitivity in choledocholithiasis is 100 %, in PDZ tumors - 75 %, in strictures - 65 %, in indurative pacreatitis - 50 %. Conclusions. When suspecting the calculous character of disease, ERCG is the most effective method for differential diagnosis of mechanical jaundice. Differential diagnosis of acalculous mechanical jaundice is most difficult. In the majority of cases, we have to use successively some diagnostic methods, that proves their insufficient effectiveness.

Mechanical jaundice, differential diagnosis, sensitivity