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Reminder of important clinical lesson
Choledocholithiasis presenting with very high transaminase level
  1. Amy Agahi,
  2. Alistair McNair
  1. Department of Specialist Medicine, Queen Elizabeth Hospital, London, UK
  1. Correspondence to Dr Alistair McNair, a.mcnair{at}


We present three cases of choledocholithiasis presenting with a rise in transaminase to levels normally associated with acute hepatitis (alanine aminotransferase in excess of 1000 IU/l). All three cases had repeated investigation for liver disease before identification of common bile duct stones with magnetic resonance cholangiopancreatogram, and removal at endoscopic retrograde cholangiopancreatogram. We discuss the existing literature and the potential mechanisms of hepatocyte injury in extrahepatic obstruction.

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