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| Intrahepatic cholestasis without jaundice |
| Thomas Namdar, Andreas Raffel, Stefan Andreas Topp, Jan Schulte am Esch, Günther Fürst, Wolfram Trudo Knoefel and Claus Ferdinand Eisenberger |
Düsseldorf, Germany
Author Affiliations: Department of General, Visceral and Pediatric Surgery (Namdar T, Raffel A, Topp SA, Schulte am Esch J, Knoefel WT and Eisenberger CF) and Institute of Diagnostic Radiology (Fürst G), Heinrich-Heine University, Düsseldorf, Germany
Corresponding Author: Andreas Raffel, MD, Department of General, Visceral and Pediatric Surgery, Heinrich-Heine University, Moorenstrasse 5, 40225 Düsseldorf, Germany (Email: raffel@med.uni-duesseldorf.de) |
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Abstract BACKGROUND: Cholangiocarcinoma (CC), the most common biliary tract malignancy, is frequently seen in advanced unresectable stages and is typically localized extrahepatically. Early diagnosis is unusual because of nonspecific symptoms. Painless jaundice is usually the first sign of tumor.
METHOD: We present a patient with a CC (Klatskin tumor) with a complete biliary drainage by an aberrant bile duct without jaundice.
RESULTS: A 67-year-old woman presented with persisting elevation of liver parameters. Diagnostic tests showed a Klatskin tumor type Ⅱ. A curative right hepatic trisegmentectomy was performed after liver volume augmentation by preoperative vein embolization.
CONCLUSIONS: A direct drainage of the right posterior bile duct into the common bile duct as an aberrant hepatic duct is a rare variation and is present in less than 5% of the population. In case of persistently perturbed liver function tests, an aberrant bile duct can cover up severe intrahepatic cholestasis and even obscure the diagnosis of a Klatskin tumor. Up to now it has not been described in the literature.
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2009, Vol. 8 
