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Published on: November 25, 2025

Highly elevated serum levels of CA 19-9 in choledocholithiasis: a case report

Georgios Marcouizos1, Eleftheria Ignatiadou, Georgios E Papanikolaou

  • 1Department of Surgery, University Hospital of Ioannina, School of Medicine Ioannina Greece. gmarcouizos@freemail.gr

Cases Journal
|October 16, 2009
PubMed

Insights

This case study details a patient with elevated carbohydrate antigen 19-9 (CA 19-9) levels and jaundice, successfully treated with surgery. Post-operative monitoring confirmed normalization of CA 19-9 and biliary tree structure.

Area of Science:

  • Gastroenterology and Hepatology
  • Diagnostic Imaging
  • Oncology

Background:

  • Elevated carbohydrate antigen 19-9 (CA 19-9) is a biomarker often associated with gastrointestinal malignancies, particularly pancreatic and biliary cancers.
  • Jaundice, right upper quadrant abdominal pain, fever, and chills are classic symptoms indicative of biliary obstruction.

Observation:

  • A 79-year-old female presented with right upper quadrant pain radiating to the back, jaundice, fever, and chills.
  • Initial laboratory findings revealed significantly elevated serum CA 19-9 (99,070 U/ml), alkaline phosphatase (550 IU/l), and bilirubin levels (direct 17.5 mg/dl, total 28.4 mg/dl).
  • Abdominal sonography showed a dilated common bile duct, suggesting obstruction.

Findings:

  • Post-operative CA 19-9 levels decreased from 99,070 U/ml to 970 U/ml within two weeks and normalized (31 U/ml) by two months.
  • Magnetic resonance cholangiopancreatography (MRCP) performed postoperatively confirmed a normal biliary tree and common bile duct configuration.
  • The patient's symptoms resolved following surgical intervention.

Implications:

  • This case highlights the importance of CA 19-9 as a tumor marker and its utility in monitoring treatment response in biliary tract conditions.
  • Serial monitoring of CA 19-9 levels can aid in assessing the effectiveness of surgical intervention and detecting recurrence.
  • Integrated diagnostic approaches, including imaging and tumor markers, are crucial for accurate diagnosis and management of biliary diseases.

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