DOI: https://doi.org/10.36347/sjmcr.2025.v13i10.039

Pages: 2348-2352

Background: Postoperative hyperbilirubinemia (PHB) is a relatively frequent complication after cardiac surgery, typically transient and multifactorial. Persistent and progressive forms, however, warrant further investigation to rule out serious underlying pathology. Case Presentation: We report the case of an 82-year-old North African woman who developed severe and persistent hyperbilirubinemia following double valve replacement surgery. Initial investigations pointed to common causes such as hemolysis, hepatic congestion, and sepsis, all of which were addressed through appropriate therapeutic measures. Despite these interventions, bilirubin levels continued to rise, with a predominance of the unconjugated fraction. A biliary Magnetic Resonance Imaging (MRI) revealed dilation of the Wirsung duct and intra- and extrahepatic bile ducts, raising suspicion of a pancreatic head tumor or intraductal papillary mucinous neoplasm (IPMN). The patient was subsequently referred to gastroenterology for further evaluation which confirmed a diagnosis of pancreatic adenocarcinoma. This delayed but critical finding underscored the importance of a comprehensive diagnostic approach in atypical cases of postoperative jaundice. Conclusion: This case illustrates the complexity of diagnosing and managing postoperative hyperbilirubinemia in cardiac surgery patients. It highlights the need for high clinical vigilance, structured differential diagnosis, and timely imaging when bilirubin levels remain elevated despite resolution of common perioperative complications.