Unusual presentation of recurrent hepatocellular carcinoma as obstructive jaundice 15 years after liver transplant

Hepatocellular carcinoma recurrence is a known limitation of liver transplant. Recurrence rates have been reported in 10% to 60% of patients within an average of 1 to 2 years following liver transplant. We report a case of recurrent hepatocellular carcinoma 15 years after orthotopic liver transplant, presenting initially as obstructive bile duct compression as detected by cholangiogram. Laparotomy revealed hepatocellular carcinoma invading the common bile duct without any mass in the liver parenchyma. The main focus of the case is the encloscopic retrograde cholangiopancreatography image, which is unique in the setting of liver disease following liver transplant.