Obstructive jaundice caused by hepatocellular carcinoma

Hepatocellular carcinoma can be complicated by obstructive jaundice with tumor growing into the extrahepatic bile duct. This complication is an autopsy finding in most reported cases and, rarely, is recognized ante mortem. We report two patients with hepatocellular carcinoma who presented initially with obstructive jaundice. Clotted blood and tumor, which caused bile duct obstruction, was removed operatively and the biliary tract was drained in both patients. We conclude that blood clot and fleshy debris removed from the common bile duct at operation for obstructive jaundice suggests the possibility of hepatocellular carcinoma; the differential diagnosis of jaundice and fever in patients known to have hepatocellular carcinoma should include intrabiliary tumor causing obstruction and cholangitis; and the association of obstructive jaundice and hepatocellular carcinoma may occur more often than previously recognized.