Unsuspected infective cholestatic jaundice after bilateral tubal ligation

Severe bacterial infection from a primary septic focus remote from the liver is accepted to be a cause of hepatic dysfunction. This may range from minor biochemical abnormality of standard liver function tests to fulminant hepatic failure. This report highlights a presentation with deep obstructive-type jaundice associated with profound bio-chemical changes suggestive of cholestatic hepatitis. There was no clinical indication of infection during the first 4 weeks and at admission. As a result, the absence of fever and leucocytosis was misleading. Halothane hepatitis was the working diagnosis until the sixth week when pelvic sepsis emerged as the possible cause. However, drainage of the abscess led to prompt clinical and biochemical resolution of jaundice so that it is unlikely that halothane exposure was a primary contributing cause. In addition, other common causes of jaundice were excluded by serological and sonographic screening. This case was an unusual case in which the cause of cholestatic jaundice occurred after a minor gynaecological operation commonly performed in developing countries (AU)