A Resected Case of Non-Icteric Hilar Cholangiocarcinoma from Which Magnetic Resonance Cholangiopancreatography after an Operation for Cholecystitis Became the Opportunity for Diagnosis

We report herein a case of non-icteric hilar cholangiocarcinoma after acute cholecystitis, in which radical excision was possible. A 67-year-old man was examined at an affiliated hospital because of abdominal pain and vomiting, and underwent a cholecystectomy based on a diagnosis of acute cholecystitis in September 2001. Postoperative magnetic resonance cholangiopancreatography (MRCP) showed a filling defect in the common hepatic duct, and he was referred to our hospital. On admission, the serum total bilirubin value was normal at 1.0mg/dl, and the serum level of biliary enzymes was not elevated. Abdominal ultrasonography visualized no dilation of the intrahepatic bile duct. In December of the same year, a right hepatectomy with caudate lobectomy and resection of the extrahepatic bile duct were performed based on a diagnosis from close examinations of hilar cholangiocarcinoma with few sites of stenosis, thought to have progressed from the superior bile duct to the right hepatic duct. Although several cases of non-icteric hilar cholangiocarcinoma have been reported, most are accompanied by an elevation in the serum level of biliary enzymes or dilation of the intrahepatic bile duct. In this case, we considered that the correct diagnosis could only have been obtained only with MRCP, and the usefulness of this examination method is suggested.