A STOOL specimen was sent to the laboratory with a request for a heavymetal screen. On examination, a metallic silver sheen was noted (Figure). The test for occult blood was positive, and the test for bile was negative.
Report of a Case
A 78-year-old woman was admitted to the hospital because of jaundice, weight loss, and dehydration. Physical examination showed she was cachectic and deeply jaundiced with icteric scleras. No abdominal masses were palpated. Rectal examination showed 4+ guaiac-positive stools. Pertinent laboratory findings included the following: hemoglobin, 12 g/dL; hematocrit, 34.7%; total bilirubin, 10 mg/dL; direct bilirubin, 7.3 mg/dL; SGOT, 67 IU/L; and alkaline phosphatase, 668 IU/L.Abdominal ultrasonography showed massive dilation of the common duct, an obstruction presumably caused by a neoplasm in the head of the pancreas. Percutaneous transhepatic cholangiography showed complete obstruction of the distal common bile duct, characterized by tapered, slightly asymmetric narrowing consistent with compression