Spontaneous fracture of a nasobiliary catheter

A 68-year-old-man was referred to our hospital because of obstructive jaundice and ascites. Laboratory tests showed elevated levels of alkaline phosphatase, ?-glutamyltransferase, and bilirubin (24.8 mg/dL ; normal < 1.2 mg/dL). Magnetic resonance cholangiopancreato- graphy revealed a mass with a diameter of 32 × 24 mm in the junction of the right and left hepatic ducts. Ascitic fluid analysis showed a malignant cytology. Positron emission tomography revealed increased FDG uptake of the mass and celiac, superior mesenteric and preaortic lymph nodes. Tumor antigen CA 19-9 level was 496 U/L (normal < 37 U/L). Based on these findings, a diagnosis of inoperable Klatskin tumor was established.