CASE REPORT
Extreme hyperbilirubinaemia associated with choledocholithiasis without ascending cholangitis
Ikhwan Sani Mohamad 1, 2  
,   Syed Hassan Syed Aziz 1, 2  
,   Ong Yan Zie 1, 2  
,   LEOW Voon Meng 3  
,   Zaidi Zakaria 1, 2  
 
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1
Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
2
Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
3
Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Pulau Pinang, Malaysia
CORRESPONDING AUTHOR
Ikhwan Sani Mohamad   

Department of Surgery, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150 Kota Bharu, Kelantan, Malaysia.
Submission date: 2020-04-08
Final revision date: 2020-09-18
Acceptance date: 2020-09-18
Online publication date: 2021-06-06
 
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Charcot’s triad was traditionally used to diagnose ascending cholangitis. However it is already proven that only minority of patients with ascending cholangitis who fulfill the triad of fever, jaundice and right hypochondriac pain.

Aim:
We would like to highlight the rarity of severe hyperbilirubinaemia secondary to benign cause as most of the incidence raised more suspicion for primary liver disease or malignancy.

Case study:
We presented a case report of a 58-year-old male patient with no comorbid who presented to us with right hypochondriac pain and obstructive jaundice with severe hyperbilirubinaemia (total bilirubin 1025 µmol/L), without fever or leukocytosis.

Results and discussion:
We presented a case report of a 58-year-old male patient with no comorbid who presented to us with right hypochondriac pain and obstructive jaundice with severe hyperbilirubinaemia (total bilirubin 1025 µmol/L), without fever or leukocytosis.

Conclusions:
Benign conditions such as common bile duct stones still can lead to severe hyperbilirubinaemia even though it is very rare. The usage of appropriate imaging is needed to exclude malignant causes.

ACKNOWLEDGEMENTS
We would like to thank the Department of Surgery USM and Endoscopy Unit USM for contribution in getting patient’s data and images.
FUNDING
This manuscript is not funded by any organization.
CONFLICT OF INTEREST
No conflict of interest.
 
REFERENCES (11)
1.
Pratima B, Gyanranjan N, Sitanshu KP, Mahesh CS. Asymptomatic gall stone disease: A clinicopathological correlation. Pol Ann Med. 2018;25(2):218–223. https://doi.org/10.29089/2017.....
 
2.
Song SH, Kwon CI, Jin SM, et al. Clinical characteristics of acute cholecystitis with elevated liver enzymes not associated with choledocholithiasis. Eur J Gastroenterol Hepatol. 2014;26(4):452–457. https://doi.org/10.1097/meg.00....
 
3.
Frossard JL, Morel PM. Detection and management of bile duct stones. Gastrointest Endosc. 2010;72(4):808–816. https://doi.org/10.1016/j.gie.....
 
4.
Mulgund AA, Gray M, Poreddy S, Smith M, Giannella R. Painless Jaundice: A Happy Ending. Am J Gastroenterol. 2017;112(Suppl 1):S1520–S1521.
 
5.
Copelan A, Kapoor BS. Choledocholithiasis: Diagnosis and Management. Tech Vasc Interv Radiol. 2015;18(4):244–255. https://doi.org/10.1053/j.tvir....
 
6.
Lee JH, Lee SR, Lee SY, Kim HH, Park JH, Ryu SH, Kim YS, Moon JS. [The usefulness of endoscopic ultrasonography in the diagnosis of choledocholithiasis without common bile duct dilatation]. Korean J Gastroenterol. 2010;56(2):97–102. https://doi.org/10.4166/kjg.20... [in Korean].
 
7.
Komarowska M, Snarska J, Troska P, Suszkiewicz R. Recurrent residual choledocholithiasis after cholecystectomy–endoscopic exploration of bile ducts performed 6 times. Pol Ann Med. 2011;18(1):118–124.
 
8.
Maple JT, Ben-Menachem T, Anderson MA, et al.; ASGE Standards of Practice Committee. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc. 2010;71(1):1–9. https://doi.org/10.1016/j.gie.....
 
9.
Cohen ME, Slezak L, Wells CK, Andersen Dk, Topazian M. Prediction of bile duct stones and complications in gallstone pancreatitis using early laboratory trends. Am J Gastroenterol 2001;96(12):3305–3311. https://doi.org/10.1111/j.1572....
 
10.
Isherwood J, Garcea G, Williams R, Metcalfe M, Dennison AR. Serology and ultrasound for diagnosis of choledocholithiasis. Ann R Coll Surg Engl. 2014;96(3):224–228. https://doi.org/10.1308/003588....
 
11.
Dziadkowiec KN, Simms LN, Smith SGA, Katz A, Olowe K. Acute obstructive choledocholithiasis: A case of elusive gallstones on imaging. Cureus. 2020;12(6):e8489. https://doi.org/10.7759/cureus....