Abstract
Metastatic lesions from colorectal cancer (CC) have been described in the common bile duct [1,2], whereas their occurrence in the intrahepatic biliary tree is extremely rare. We describe the case of a 75-year-old man who underwent an anterior rectal resection for a lower third rectal adenocarcinoma at moderate degree of differentiation initially infiltrating the muscular layer but none out of the 21 examined nodes (Dukes A; Jass 1; Astler-Coller B1; T2 N0 Mx). Twenty-eight months after surgery, the patient complained abdominal pain in the right upper quadrant, mild and transient jaundice without nausea and/or vomiting and fever. Liver function tests were as follow: ALT 47 U/L; AST 57 U/L; alkaline phosphatase level 138 U/L; gamma-glutamyltransferase level 246 U/L; total bilirubin 1.76 mg/dl. Hepatitis A, B and C markers were negative. CEA level was 36.6 ng/ml (n.v.: 0.0–5.0) and Ca 19–9Gica was 120.6 ng/ml (n.v.: 0.0–37.0).
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