Extreme hyperbilirubinaemia associated with choledocholithiasis without ascending cholangitis

Introduction: Charcot’s triad was traditionally used to diagnose ascending cholangitis. However it is already proven that only minority of patients with ascending cholangitis who fulfill the triad of fever, jaundice and right hypochondriac pain. Aim: We would like to highlight the rarity of severe hyperbilirubinaemia secondary to benign cause as most of the incidence raised more suspicion for primary liver disease or malignancy. Case study: We presented a case report of a 58-year-old male patient with no comorbid who presented to us with right hypochondriac pain and obstructive jaundice with severe hyperbilirubinaemia (total bilirubin 1025 µmol/L), without fever or leukocytosis. Results and discussion: We presented a case report of a 58-year-old male patient with no comorbid who presented to us with right hypochondriac pain and obstructive jaundice with severe hyperbilirubinaemia (total bilirubin 1025 µmol/L), without fever or leukocytosis. Conclusions: Benign conditions such as common bile duct stones still can lead to severe hyperbilirubinaemia even though it is very rare. The usage of appropriate imaging is needed to exclude malignant causes.