title: Acute pancreatitis and obstructive jaundice as initial complaints of hepatocellular carcinoma: case report.
abstract: BACKGROUND
  Patients with cirrhosis-associated hepatocellular carcinoma (HCC) rarely present with acute pancreatitis (AP) and obstructive jaundice as the main clinical features. AP with obstructive jaundice caused by common bile duct embolism (CBDE) is very rare.
  
  
  METHODS
  A 54-year-old man with CBDE was misdiagnosed with common bile duct stones three times over a 7-month period. Investigations during this time did not identify CBDE. Surgical exploration was performed because of AP, obstructive jaundice, and a tumor in the left lobe of the liver. CBDE from the hepatic tumor was diagnosed by intraoperative biopsy and frozen section examination. The patient underwent left hemihepatectomy, cholecystectomy, and bile duct exploration.
  
  
  CONCLUSIONS
  Preoperative diagnosis of CBDE is difficult because of the rarity of the condition, lack of physician awareness, and easy misdiagnosis on imaging examinations. Early and accurate diagnosis of this condition is important.
authors.forename: Guo-Qing
authors.initials: GQ
authors.lastname: Jiang
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Qian
authors.forename: Jie
authors.initials: J
authors.lastname: Yao
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Jin
authors.affiliation: Department of Hepatobiliary Surgery, Clinical Medical College of Yangzhou University, 98 West Nantong Road, Yangzhou 225000, Jiangsu Province, China. bdsno1@hotmail.com.
authors.forename: Dou-Sheng
authors.initials: DS
authors.lastname: Bai
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D002763:Cholecystectomy; D002779:Cholestasis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D003135:Common Bile Duct / Q000473:pathology* / Q000601:surgery; D004617:Embolism / Q000150:complications*; D006801:Humans; D041781:Jaundice, Obstructive / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D011379:Prognosis