Users Online : 2989 About us |  Subscribe |  e-Alerts  | Feedback | Login   |   
Journal of Minimal Access Surgery Current Issue | Archives | Ahead Of Print Journal of Minimal Access Surgery
           Print this page Email this page   Small font sizeDefault font sizeIncrease font size 
 ¤   Similar in PUBMED
 ¤  Search Pubmed for
 ¤  Search in Google Scholar for
 ¤   Article in PDF (122 KB)
 ¤   Citation Manager
 ¤   Access Statistics
 ¤   Reader Comments
 ¤   Email Alert *
 ¤   Add to My List *
* Registration required (free)  

 ¤  References

 Article Access Statistics
    PDF Downloaded84    
    Comments [Add]    
    Cited by others 1    

Recommend this journal


 Table of Contents     
Year : 2016  |  Volume : 12  |  Issue : 1  |  Page : 90

CBD compression or Quincke's triad?

Department of Abdominal Surgery, Vladimir City Clinical Hospital of Emergency Medicine, Vladimir, Russia

Date of Web Publication17-Dec-2015

Correspondence Address:
Mahir Gachabayov
Stavrovskaya Street, 6-73, Vladimir - 600022
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-9941.172007

Rights and Permissions

How to cite this article:
Gachabayov M. CBD compression or Quincke's triad?. J Min Access Surg 2016;12:90

How to cite this URL:
Gachabayov M. CBD compression or Quincke's triad?. J Min Access Surg [serial online] 2016 [cited 2021 Dec 3];12:90. Available from:


First of all, I would like to extend my thanks to Dr. Hsiao and co-authors for the interesting report of an unusual case, 'Obstructive jaundice as a complication of a right hepatic artery pseudoaneurysm after laparoscopic cholecystectomy'. [1] I read the article with enthusiasm but got a bit confused. Therefore I would like to present two comments.

First comment: The authors stated that obstructive jaundice due to hepatic artery pseudoaneurysm had never been reported before. However, Peter et al. published a case of obstructive jaundice in a patient with severe haemobilia due to common hepatic artery pseudoaneurysm (5.7 × 5.3 cm) in 2014. [2]

Second comment: This involves the pathophysiology of obstructive jaundice. Starting with the abstract, I realised that the condition the patient had was haemobilia because of the clinical presentation, that is, tarry stools and obstructive jaundice. But later in the discussion it is stated that endoscopy was not performed because of the absence of gastrointestinal bleeding. So the key question is: What is the pathogenesis of obstructive jaundice, common bile duct (CBD) compression or Quincke's triad? If the patient had haemobilia, the clinical presentation of haemobilia is Quincke's triad (biliary colic, melena and obstructive jaundice). Of these elements, obstructive jaundice is seen in 60% of all haemobilia cases, biliary colic in 70% and melena in 90%. [3] The pathophysiological mechanism of jaundice in haemobilia is CBD obstruction by blood clots formed in pseudo-aneurysmal sac and transferred to CBD via fistula. Thus, CBD compression is not mandatory for the development of obstructive jaundice in a patient with haemobilia. Regarding imaging, air bubbles, blood clots and metallic clips in CBD can also lead to false positive diagnoses of choledocholithiasis or CBD obstruction.

To conclude, the case presented by Hsiao et al. is an interesting case with informative high-quality figures, but the aetiology of obstructive jaundice is debatable. In addition, it is worth emphasising that haemobilia, which is encountered in surgical practice increasingly owing to the development of minimally invasive surgery, is still a challenge requiring prompt and adequate diagnosis and treatment; moreover, requiring prevention by improving navigation in minimally invasive liver procedures and precise surgical technique.

Financial Support and Sponsorship


Conflicts of Interest

There are no conflicts of interest.

 ¤ References Top

Hsiao CY, Kuo TC, Lai HS, Yang CY, Tien YW. Obstructive jaundice as a complication of a right hepatic artery pseudoaneurysm after laparoscopic cholecystectomy. J Min Access Surg 2015;11:163-4.  Back to cited text no. 1
[PUBMED]  Medknow Journal  
Peter G, Shaheer R, Narayanan P, Vinayakumar KR. Hepatic artery aneurysm: A rare case of obstructive jaundice with severe hemobilia. Ann Gastroenterol 2014;27:288-9.  Back to cited text no. 2
Green MH, Duell RM, Johnson CD, Jamieson NV. Haemobilia. Br J Surg 2001;88:773-86.  Back to cited text no. 3

This article has been cited by
1 Revisiting Quincke’s Triad: A Case of Idiopathic Hepatic Artery Aneurysm Presenting with Obstructive Jaundice
Indah Jamtani, Adianto Nugroho, Witra Irfan, Mursid Fadli, Rofi Y. Saunar, Aditomo Widarso, Taslim Poniman
Annals of Vascular Surgery. 2021; 71: 536.e1
[Pubmed] | [DOI]


Print this article  Email this article


© 2004 Journal of Minimal Access Surgery
Published by Wolters Kluwer - Medknow
Online since 15th August '04