calcium oxalate, phosphate, struvite, uric acid, and cysteine make up the majority of urinary stones. Moreover, only 0.5 -3.5 percent of urinary stones have a different composition. A thorough history, physical examination, along with urinary stone analysis helps to diagnose the cause of rare urinary stones.

We herein report a case of pancreatic cancer with the unusual presentation of renal colic and ureteral stones. After removing the stones with ureterolithotripsy, the stone analysis revealed bilirubin crystal composition. Upon further follow-up, the patient has diagnosed with adenocarcinoma of the head of the pancreas.

 This case highlights the importance of stone analysis, while many urologists do not consider this, and this is my result in miss diagnosis of some dangerous diseases that may present with the uncommon presentation.