title: Intrahepatic cholestasis without jaundice.
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.
  
  
  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.
authors.affiliation: Department of General, Visceral and Pediatric Surgery, Heinrich-Heine University, Düsseldorf, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Namdar
authors.forename: Andreas
authors.initials: A
authors.lastname: Raffel
authors.forename: Stefan Andreas
authors.initials: SA
authors.lastname: Topp
authors.forename: Jan Schulte
authors.initials: JS
authors.lastname: am Esch
authors.forename: Günther
authors.initials: G
authors.lastname: Fürst
authors.forename: Wolfram Trudo
authors.initials: WT
authors.lastname: Knoefel
authors.forename: Claus Ferdinand
authors.initials: CF
authors.lastname: Eisenberger
mesh_terms: 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