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A 66-year-old female who had history of asymptomatic gallstone for three years was referred to our clinic because of a 14-day jaundice and dark-colored urine. Physical examination showed the liver being palpable under the right hypochondrium. Biochemistry assay showed alanine aminotransferase 87 U/L, total bilirubin 115.9 μmol/L, and direct bilirubin 93.8 μmol/L. Carcinoembryonic antigen (CEA) lever was within normal range, but carbohydrate 19-9 (CA19-9) lever was significant elevated (285.9 U/mL).