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Background: Jaundice is a clinical symptom as a result of cholestasis. It can be caused by a wide variety of disorders. Its differential diagnosis is broad. Therefore, it is important to determine whether the cause of the cholestasis is intrahepatic, hepatic or extrahepatic. Case description This article describes a 61-year-old male who was referred to our Gastroenterology Department. Transabdominal ultrasound showed dilatation of intrahepatic bile ducts and the common bile duct, probably caused by a sludge ball. He underwent an ERCP during which a mass instead of a gallstone was extracted. Histological examination showed (a metastasis of) a melanoma. The patient was referred to the dermatologist who found a melanoma on the chest. The final diagnosis was metastasis of melanoma to the common bile duct., Conclusion: Jaundice can be caused by a variety of disorders. A systematic approach based on signs and symptoms is essential to recognize uncommon diagnoses without unnecessary delay.

Background: Diseases of the pancreas may present with extrapancreatic symptoms, such as (poly)arthritis or necrosis of subcutaneous fat. A combination of pancreatitis, panniculitis and (poly)arthritis is referred to as the PPP syndrome, which is associated with acute and chronic pancreatitis, as well as pancreatic malignancies., Case Description: This article describes a patient which was admitted to our hospital with severe polyarthritis and panniculitis. A meticulous work-up revealed an underlying focal alcoholic pancreatitis. The clinical course in our patient illustrates the severity of the PPP syndrome and emphasizes the need of a multidisciplinary approach., Conclusion: Panniculitis and/or (poly)arthritis may be the first symptom of underlying pancreatic disease. Timely recognition and diagnosis is imperative for successful treatment and outcome. The multi-organ involvement in the PPP syndrome requires close collaboration across different medical departments.