A Case of Choledocholithiasis and Obstructive Jaundice With a Very High Serum Carbohydrate Antigen 19-9 (CA 19-9) Level: A Case Report and Review of Literature

Abstract

Carbohydrate antigen 19-9 (CA 19-9) is a tumor marker used clinically to support the diagnosis and recurrence of pancreatic adenocarcinoma. CA 19-9 levels may be found to be elevated too in benign conditions, including hepatobiliary diseases such as choledocholithiasis, cholangitis, or cholestasis of any etiology. In this case, we are presenting a case of a 66-year-old man who has presented with diffuse abdominal pain and has been then found to have choledocholithiasis and obstructive jaundice treated with biliary sphincterotomy and balloon extraction. In the setting of extensive unclear gastroenterological surgeries, tumor markers were obtained, and the results revealed markedly elevated CA 19-9 with negative other tumor markers and a negative workup for malignancy. After reviewing the literature, we found that although CA 19-9 has been studied in diagnosing pancreatic and biliary malignancies, the serum level may also be elevated in many other benign conditions. As a result, the results must be individualized according to the clinical scenario of each patient.

Keywords: ca 19-9; choledocholithiasis; cholelithiasis; obstructive jaundice; tumor markers.

Figure 1. CT abdomen and pelvis without contrast showing markedly distended gallbladder (arrow) with minimal pericholecystic edema

CT: computed tomography

Figure 2. Magnetic resonance cholangiopancreatography shows a distended gallbladder (arrow) with numerous gallstones inside

Figure 3. Magnetic resonance cholangiopancreatography shows a distended gallbladder with gallstones and shows dilated CBD blocked by a stone (arrow)

CBD: common bile duct