A black liver in Dubin-Johnson syndrome: Does it matter?

A 28-year-old female presented with recurrent chronic abdominal pain. An abdominal ultrasound revealed cholelithiasis, characterized by two large stones and several smaller ones. Laboratory tests including liver function tests were within normal limits. A laparoscopic cholecystectomy revealed an enlarged dark black liver, with round margins suggestive of Dubin Johnson syndrome (Figure 1), while the Gallbladder was distended with multiple calculi inside. Successful laparoscopic cholecystectomy was done with a liver biopsy. Histopathology of the gallbladder revealed chronic cholecystitis. A liver biopsy confirmed the diagnosis of DubinJohnson syndrome. The follow-up was uneventful.