Biliary stenosis, hepatitis A and valsartan: multifactorial hepatotoxicity in a surgical patient

We present the case of a male patient with a history of hypertension who developed acute lithiasic cholecystitis. Shortly before the patient's admission, valsartan was prescribed to control his blood pressure. Surgery was performed without complications, but during the immediate postoperative period he developed marked jaundice, light colored stools, dark urine, and malaise. A cholangiogram showed a mild stricture of the common bile duct, and laboratory analyses revealed IgM antibodies against hepatitis A virus. Moreover, the patient reported the he continued to take valsartan. The patient improved with conservative treatment without any further complaints. In patients with jaundice after biliary surgery, exhaustive studies must be carried out before reintervention is performed, including investigation of the administration of drugs with potential hepatotoxic effects.