A 74-year-old man referred to our institute complained of asthenia and jaundice associated with altered laboratory liver tests. The patient's history included cardiopathy, dyslipidemia, arterial hypertension, and partial gastrectomy with Billroth II reconstruction due to a peptic ulcer. Abdominal ultrasound showed dilation of intrahepatic bile ducts associated with hepatic hilar tissue, strongly suspected for hilar tumor (Klatskin type IV according to Bismuth-Corlette classification) [1-3] on

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... mputed tomography (CT) scan (▶ Fig. 1 ), associated with low grade intra-abdominal fluid. Neoplastic markers (carbohydrate antigen 19-9, carcinoembryonic antigen, and alpha-fetoprotein) were negative. Percutaneous transhepatic-cholangiography with brushing and biliary internalexternal 10-Fr drainage placement was considered the best option. Cytology examination was inconclusive.