Intrahepatic cholestasis without jaundice.
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.


METHODS
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.
Namdar
Thomas
T
Department of General, Visceral and Pediatric Surgery, Heinrich-Heine University, Düsseldorf, Germany.
Raffel
Andreas
A
Topp
Stefan Andreas
SA
am Esch
Jan Schulte
JS
Fürst
Günther
G
Knoefel
Wolfram Trudo
WT
Eisenberger
Claus Ferdinand
CF
D000368:Aged; D001650:Bile Duct Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D002780:Cholestasis, Intrahepatic / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D003135:Common Bile Duct / Q000002:abnormalities*; D005260:Female; D006500:Hepatic Duct, Common / Q000002:abnormalities*; D006801:Humans; D007565:Jaundice; D018285:Klatskin Tumor / Q000150:complications* / Q000473:pathology / Q000601:surgery; D008111:Liver Function Tests