Refractory pancreatitis secondary to ruptured hepatocellular carcinoma into the common bile duct

Hepatocellular carcinoma (HCC) is a common disease worldwide and continues to be the leading cause of death of males in Taiwan. Jaundice is present in 19-44% of cases of HCC at the time of diagnosis and are usually attributed to the preexisting liver cirrhosis or extensive hepatic parenchymal destruction by tumor (1). Uncommonly, the main extrahepatic bile duct is occluded either by tumor infiltration or by tumor debris and blood clots, giving a peculiar pattern of obstructive jaundice known as icteric hepatoma (2). In 1947, Mallory first described a case of HCC invading the gallbladder with obstruction of the extrahepatic bile duct (3). Since then, this unusual disease entity has been increasingly recognized, with a reported incidence of 1.2-9% of HCC (4-6). Similar to the previous reports, we have also seen icteric hepatoma occurring in 3.5% of 510 patients with HCC (7). Icteric hepatoma is characterized by intermittent obstructive jaundice with associated complications, such as cholangitis and hemobilia (3-7). Here we reported the first case of icteric hepatoma that initially presented as pancreatitis in addition to obstructive jaundice.