Histopathologic examination revealed epitheloid granulomatous with caseating necrosis and presence of Langerhan’s giant cells. Therefore, postoperative diagnosis Fluorouracil was revealed tuberculosis of cholecystitis. The patient tolerated the procedure well and was discharge 1 week following surgery without any problems. The patient was started on anti tubercular treatment. Conclusion: Herein, we present a case of tuberculous cholecystitis with cholecysto-colonic fistula.

Key Word(s): 1. tuberculosis cholecystitis; 2. cholecysto-colonic fistula Presenting Author: JIN KYEONG CHO Additional Authors: Na Corresponding Author: JIN KYEONG CHO Affiliations: Seoul Medical Center Objective: Introduction After successful common bile duct (CBD) stone removal by endoscopic retrograde cholangiopancreatography (ERCP), high prolonged jaundice is very confused for the next decision (ERCP for remnant stone or other rare causes). With assurance of removal Cetuximab of CBD stone and no remnant stone, Liver biopsy may be useful for jaundice of parenchymal origin but invasive. In such cases, steroid challenge test is useful both diagnosis and treatment. Case description

A 62-year-old male presented with colicky right upper quadrant pain. Laboratory tests showed total bilirubin of 7.6 mg/dL, aspartate aminotransferase (AST) 60 IU/L, alanine aminotransferase (ALT) 15 IU/L, alkaline phosphatase (ALP) 60 IU/L and gamma-glutamyltranspeptidase

(γ-GT) 71 IU/L. At abdomen CT, There was single 1.3 cm sized distal CBD stone and diffuse dilatation of upstream bile duct and cystic duct. The patient underwent endoscopic retrograde biliary drainage (ERBD) by plastic stent because of long procedure time for cannulation. But 5 days after the ERBD, his total bilirubin increased to 18.7 mg/dL. A second ERCP was carried out, which revealed patent biliary stent and CBD stone was removed successfully. After 2 days of second ERCP, total bilirubin level increased to 19.5 mg/dL. At second abdomen CT, there was no remnant stone. It was presumed that intrahepatic cholestasis was occurred by intrahepatic bile duct inflammation from contrast agent or pethidine. 上海皓元医药股份有限公司 P rednisolone was started (30 mg/day) for three days, which caused a significant improvement of jaundice and bilirubin level. But 7 days later, his bilirubin raised up to 20.3 mg/dL. It was certain that prednisolone improved his cholestasis. Prednisolone started again and after use of 30 mg/day of prednisolone for 7 days, total bilirubin fell to 10 mg/dL, and his jaundice was progressively declined. Steroid was used and tapered off during a month. He had normal bilirubin level and normal liver function tests. Key Word(s): 1. ERCP; 2.