Advanced hyperbilirubinemia simulating obstructive jaundice after choledocholithotomy. Report of a case.

A case of intrahepatic cholestatic jaundice of unclear etiology and unusual course is described. A male patient underwent choledocholithotomy after PTC, showing a normal immediate postoperative recovery, but after a few days developed a severe cholestatic jaundice despite normal postoperative cholangiograms. The liver function tests showed a biphasic picture. Bilirubin was maximally 770 mumol/l and a lower level was obtained after blood exchange and subphrenic abscess drainage. It was, however, not until prednisolone treatment was induced that a slow continuous decrease of bilirubin was seen.