Obstructive jaundice at the age of 24

A 24-year-old Afghan man, without a significant medical history, presented with right hypochondriac colicky pain for 5 days. Physical examination revealed a jaundiced patient without fever. There was tenderness on palpation of the right hypochondrium. Laboratory studies revealed predominantly cholestatic liver injury, with alkaline phosphatase level of 170 U/L (normal, <114U/L), ?-glutamyl transferase level of 259U/L (normal, < 57 U/L), total bilirubin level of 3.87 mg/dl (normal, < 1.0) and direct bilirubin level of 2.9 mg/dl (normal, < 0,5 mg/dl). Haemoglobin level, platelet count and leucocyte level (5200/mm3 with 42% neutrophils, 39,5% lymphocytes and 9,5% eosinophils) were normal at admission.