71 year old diabetic and hypertensive female patient with post op status right mastectomy and chemotherapy for right breast carcinoma presented with decreased frequency pale coloured stools , loss of appetite since one month , yellowish discolouration of both eyes for past 5 days. Her clinical examination revealed pallor, icterus and soft palpable mass over epigastric region. Lab parameters showed elevated total bilirubin 21.25 mg/dl ,direct bilirubin 16.2mg/dl ,ALP 763 iu/l, albumin 3.5gm/dl, GGT 1609 u/l ,CA 19.9 > 1000 u/ml , CEA 6.36 ,INR 0.98 , viral markers were non reactive . UGI endoscopy showed infiltrative growth between D1 and D2 segment with scope non negotiable beyond D1 . CT thorax showed post right mastectomy status , no evidence of regrowth from the post op site and lung showed multiple nodular lesions with surrounding feeding vessels in the upper lobe suggestive of metastasis. But, MRCP done showed multiple focal T2 hyperintensities in liver suggestive of metastasis , poorly marginated, heterogenous intensity mass lesion in head and uncinate process of pancreas with areas of necrosis and infiltration into CBD causing severe proximal dilatation of biliary system and paraaortic ,peripancreatic lymphadenopathy. Biopsy from the duodenum showed poorly to moderately differentiated adenocarcinoma. In view of higher staging T4N2M1 patient underwent palliative procedure PTBD and duodenal stenting for partial gastric outlet obstruction. Post procedure patient was able to tolerate feeds and improvement in the LFT on day 10 of procedure total bilirubin 4.52mg/dl, direct bilirubin 2.10 Conclusion: The initial dilemma in this case was whether the cause of deranged LFT was hepatocellular or obstructive in nature due the metastasis. Finally if resolved to be carcinoma head of pancreas causing CBD infiltration – obstructive jaundice relieved with PTBD stunting.