Lauffer JM, Baer HU, Schajor M, Halter F, Buchler MW. Choledocholithiasis at the hepatic confluence mimicking a hilar cholangiocarcinoma. Hepatogastroenterology 1998 Nov-Dec;45(24):2339-43
Department for Visceral and Transplantation Surgery, University Hospital, Inselspital, Bern, Switzerland.
Adenocarcinomas of the
bifurcation of the hepatic ducts (Klatskin tumors) are a relatively
rare cause of obstructive jaundice. Differential diagnosis includes
other neoplastic lesions, sclerosing cholangitis, Mirizzi's syndrome
and benign strictures. We present a 46 year-old white female with
a 2 month history of epigastric pain and progressive jaundice.
Endoscopic retrograde cholangiopancreaticography (ERCP) revealed
a filiform stenosis of the right hepatic duct and an obstructed
left hepatic duct, an image strongly suggestive of a Klatskin
tumor. The correct diagnosis was achieved, however, by percutaneous
transhepatic cholangiography (PTC), which disclosed a gallstone
at the common hepatic duct bifurcation and multiple small concrements
in the left hepatic duct. After endoscopic removal of the gallstones
in the biliary tree and laparoscopic cholecystectomy, the patient
was discharged on the third post-operative day. Protuberant tumors
and round biliary stones may be confused at ERCP.
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