A case of chronic idiopathic jaundice, a disease only recently recognized, is presented in detail. The disorder, usually found in young people, is manifested by chronic or intermittent fluctuating jaundice influenced by physiologic stress, with elevation of both the direct and indirect serum bilirubin, abdominal pain, and failure of the gallbladder dye to visualize on x-ray film. It differs from constitutional hyperbilirubinemia or Gilbert's disease in several respects, and is characterized by abnormal amounts of coarsely granular, brown pigment in the parenchymal cells of the liver, which is predominant in the centrolobular zones. This clinicopathologic entity probably represents an inborn deficiency in the liver's ability to excrete various substances. The liver can conjugate indirect bilirubin with glucuronic acid but then has difficulty excreting the conjugated bilirubin; hence, direct reacting bilirubin accumulates in the serum and spills over into the urine. It is unable to excrete adequately the dye used in cholecystography and cholangiography, the lipofuscin pigment which accumulates in the liver cells, and urobilinogen which may spill over into the urine. Undoubtedly many more cases will be recognized in the future. For a detailed review of the subject the reader is referred to Dubin's recent excellent comprehensive paper [ 3]. We wish to stress its importance in the differential diagnosis of jaundice and the resulting therapeutic and surgical implications.