Five patients with HCC (hepatocellular carcinoma) obstructing biliary duct presented with obstructive jaundice. The diagnosis was totally unsuspected in first two cases, patient one and two (p5=1. pt=2). Space occupying lesions seen on
ultrsonography or
C-T scan, elevated αFP, positive HBsAg. And previous history of chronic liver disease hepled in making a diagnosis of this unusual presentation of HCC. In the first 2 cases. Liver parenchymal lesions were never confirmed on perioperative imaging
studies as well as postoperative serial check ups until patient's deaths, on postoperative day 229 and 215 respectively. In 3 patients (pt=5), right hepatic lobectomy was done after initial tube decompression of the biliary system The other
patient
(pt
#1) underwent cholecystectomy. Enbloo resection of bile duct with obstructing mass. And Roux-en-Y cholangio-Jejunostomy. In 4 out of 5 cases, obstructing tumor thrombi reccurred postoperatively. Pepeated choledochoscopy was necces sary to keep
the
bile
duct free of tumor thrombi postoperatively. In conclusion, hot all the patients who present with obstructive jaundice may be terminally ill when they treated properly. The biliary drain by mean of T-tube decompression can be a palliative
procedure
of
choice in these patients. The biliary drain by mean of T-tube decompression can be a palliative procedure of choice in these patients. The ideal treatment is complete removal of the tumor by major hepatic resection. Which may not be feasible in
most
patients. However, even when patient present with resectable lesion, those who have entire biliary systems including small and medium sized duct packed with tumor thrombi would not have long survival intervals with heaptic resection.
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