In 11 years and 3 months, 2037 patients with HCC were seen and 48 patients (2.4%) were diagnosed to have obstructive icteric type HCC. Five patients were terminally ill and were not investigated further. Forty three patients were initially investigated by endoscopic retrograde cholangiography (ERC) or percutaneous transhepatic cholangiogram (PTC) and classified as having obstructive icteric type 1, 2, or 3 HCC based on the cholangiographic findings. The obstruction in type 1 HCC was due to intraluminal tumour casts and/or tumour fragments obstructing the hepatic ductal confluence or common bile duct, while intraluminal blood clots, from haemobilia, filling the biliary tree was the cause in type 2 HCC. The pathology in type 3 HCC was extraluminal obstruction by extensive tumour encasement of the intra–hepatic biliary ductal system and/or extrinsiccompression of the hepatic and common bile ductsby tumour(s) and/or malignant lymph nodes. Atthe initial ERC/PTC, 10 patients (5 resected, 50%)had obstructive icteric type 1 and 23 patients (0 resected)had obstructive icteric type 3 HCC. Of the 10patients initially classified according to cholangiographyto have obstructive icteric type 2 HCC,subsequent investigations revealed that 6 patientshad type 1 HCC (4 resectable, 67%) and 4 patientshad type 3 HCC (0 resectable). The classification ofthe obstructive icteric type HCC into types 1, 2, and3, based on the initial cholangiographic appearanceshas simplified and rationalized our managementstrategy for this condition.
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