title: Oriental cholangiohepatitis masquerading as cholangiocarcinoma: A rare presentation that surgeons need to know.
abstract: BACKGROUND
  The detection of an abnormal hepatic mass with ductal dilatation is highly concerning for malignancy. However, if such patients happen to be immigrants from endemic parts of Asia or South America, further investigations are necessary to rule out oriental cholangiohepatitis, a rare recurrent disease of the hepatobiliary system that can masquerade as cholangiocarcinoma.
  
  
  METHODS
  We report a case of a patient of South Asian origin who presented to us with acute cholangitis and moderately dilated left hepatic ducts. The findings were highly suspicious for advanced hepatic malignancy; however the laboratory and pathological investigations remained normal. We suspected an unlikely etiology and proceeded with conservative hepatic resection. The histology revealed cholangiohepatitis without any evidence of malignancy.
  
  
  CONCLUSIONS
  Cholangiohepatitis is a complex hepatobiliary disease that commonly manifests as recurrent cholangitis or overt biliary sepsis and can rarely present as an abnormal hepatic mass. It results from the development of intrahepatic or extrahepatic strictures that causes stone formation and biliary dilation in the absence of gallbladder disease. Although it is endemic in many parts of the world, it is rare in the western world, and therefore it can present as a significant diagnostic enigma.
  
  
  CONCLUSIONS
  Cholangiohepatitis is a rare clinical entity that requires a multi-disciplinary team approach. Surgery plays a dominant role in the management of such patients and therefore surgeons need to be aware of this disease.
authors.affiliation: Department of Surgery, Temple University Hospital, 3401 N. Broad Street, Philadelphia, PA 19140, USA.
authors.forename: Smit
authors.initials: S
authors.lastname: Singla
authors.forename: Anne H
authors.initials: AH
authors.lastname: Warner
authors.forename: Ashokkumar
authors.initials: A
authors.lastname: Jain
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Thomas
authors.forename: Andreas
authors.initials: A
authors.lastname: Karachristos