Amiodarone hepatotoxicity complicating obstructive jaundice due to ampullary cancer.
BACKGROUND
The presence of dual pathology can cause diagnostic dilemmas. We present a case of adenocarcinoma of the ampulla of Vater with concurrent amiodarone hepatotoxicity.


METHODS
Painless jaundice associated with a palpable gallbladder was investigated clinically, radiologically, endoscopically and via liver biopsy.


RESULTS
Liver biopsy showed amiodarone hepatotoxicity. Endoscopic biopsy identified an ampullary adenoma. However, the endoscopic ultrasound and intra-operative findings suggested a malignancy, which was confirmed postoperatively.


CONCLUSIONS
While the classic findings of Courvoisier's Law are borne out in this case, the etiology of jaundice is twofold. Although dual pathology is uncommon it should always be considered.
Collins
Anne M
AM
Department of Surgery and Hepatology, St. Vincent's University Hospital, Dublin 4, Ireland.
Winter
Des C
DC
McCormick
Aidan P
AP
Cottell
David C
DC
Geoghegan
Justin G
JG
D000236:Adenoma / Q000150:complications* / Q000188:drug therapy; D000368:Aged; D000638:Amiodarone / Q000633:toxicity*; D014670:Ampulla of Vater / Q000473:pathology*; D001706:Biopsy; D003138:Common Bile Duct Neoplasms / Q000150:complications* / Q000188:drug therapy; D005704:Gallbladder / Q000473:pathology; D006801:Humans; D041781:Jaundice, Obstructive / Q000150:complications / Q000209:etiology*; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008107:Liver Diseases / Q000150:complications; D008297:Male
D000638:Amiodarone