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A 62-year-old patient with jaundice and distal CBD obstruction
  • He is presented with obstructive jaundice and itching for 1month duration.
  • His investigation was:
    • T.S.B=13 mg/dl, direct 8.2, indirect 5.4.
    • Alk. Phosphatase 304 IU/L.
    • CBC normal apart from Hb 11.5.
    • Blood film picture consist with liver disease.
    • INR=1
  • U/S showed dilated CBD (12mm) , dilated intra � hepatic biliary tree.
  • MRCP showed CBD is dilated about 11mm in caliber with distal narrowing there is ill defined soft tissue mass at anterior aspect of distal CBD (16x14 mm) ampullary or duodenal tumor!!.
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