Abstract Delayed biliary obstruction after hepatectomy is usually attributed to calculi, strictures, or recurrent malignancy. Intraductal necrotic material of biliary epithelial origin is uncommon and may mimic sludge or stones on imaging. A 70-year-old woman with a 15-year history of hepatitis C underwent left hepatectomy and cholecystectomy for a cirrhotic nodule at another institution. Five months later, she developed progressive jaundice, intermittent abdominal pain, and fever.
