Missed Diagnosis of Cholangiocarcinoma Presenting with Atypical Symptoms.

We report a case of delayed diagnosis of cholangiocarcinoma. A 62-year-old man developed acute abdominal pain in multiple sites. As the distribution pattern of the abdominal pain was not correctly interpreted based on the mechanisms of visceral and referred pain, the patient was not investigated with the best diagnostic test at first presentation. Moreover, miscommunication between physicians in a clinic and separate hospital delayed diagnosis. For prompt diagnosis, physicians should be practice careful reasoning and focus on good communication with physicians outside their hospital. LEARNING POINTS: Abdominal pain without jaundice can be an initial symptom in patients with cholangiocarcinoma.Cholangiocarcinoma in the lower common bile duct can present as lower abdominal pain referred through the 7th-11th thoracic nerves.Physicians can determine the origin of abdominal pain through correct interpretation of the distribution pattern of abdominal pain based on knowledge of pathophysiology. © EFIM 2021.