Thoracic Duct Cannulation and Differential Diagnosis of Obstructive Jaundice

Thoracic duct cannulation was performed prior to exploratory laparotomy in 23 patients with obstructive jaundice caused by diverse factors. High flow of hemorrhagic lymph, usually under increased pressure, distinguished patients with hepatic cirrhosis from those with extrahepatic biliary obstruction and cholangiolitic hepatitis. Very low flows were observed only in patients with widespread malignancy involving the extrahepatic biliary tract. Information concerning the flow, pressure, and composition of thoracic duct lymph is helpful in understanding and distinguishing whether obstructive jaundice arises from a stone in the common bile duct, metastatic cancer, the use of a cholestatic drug, or excessive intake of alcohol.