Recurrent episodes of cholestasis with anicteric asymptomatic intervals are usually considered a manifestation of benign and/or chronic hepatobiliary tract disease. Carcinoma of the ampulla of Vater may occasionally cause fluctuating degrees of jaundice, but asymptomatic anicteric intervals are unusual. We will describe a patient with cholangiocarcinoma at the confluence of the major hepatic ducts. The patient manifested three separate episodes of jaundice; on each occasion, the jaundice cleared spontaneously without specific therapy. This case demonstrates two unusual features of bifurcation tumors: (1) notable fluctuation of jaundice, and (2) the development of secondary biliary cirrhosis, complicated by portal hypertension and esophageal varices without considerable invasion of the hepatic parenchyma or obstruction of the portal vein.
An 84-year-old man with painless jaundice was admitted to Miami Veterans Administration Hospital in April 1972 for assessment of his condition. There was no history of exposure to hepatotoxic drugs, ethanol abuse, blood transfusions,