Abstract
Background A 33-year-old white female with a history of cholecystectomy presented to the emergency department with intermittent severe abdominal pain radiating from the left upper quadrant to the right upper quadrant, associated with nausea and emesis. Three weeks previously the patient had presented to the emergency department with similar pain in the abdomen. Laboratory investigations had revealed elevated bilirubin, transaminase, and alkaline phosphatase levels. At that time, pain and liver chemistry test results improved and the patient was discharged on hospital day 3. She denied a history of alcohol use, new medications, or the ingestion of other toxins.
Investigations History and physical examination, liver chemistry tests, viral hepatitis serology tests, autoimmune serology tests, abdominal ultrasound, liver biopsy, and an endoscopic retrograde cholangiopancreatogram.
Diagnosis Choledocholithiasis.
Management Endoscopic retrograde cholangiopancreatogram with sphincterotomy, removal of an 8 mm distal common bile duct stone, and pancreatic stent placement.
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References
Menon KV et al. (2004) The Budd–Chiari syndrome. N Engl J Med 350: 578–585
Czaja AJ (2005) Current concepts in autoimmune hepatitis. Ann Hepatol 4: 6–24
Maddrey WC (2005) Drug-induced hepatotoxicity: 2005. J Clin Gastroenterol 39 (Suppl 2): S83–S89
Collins C et al. (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239: 28–33
Romagnuolo J et al. (2003) Magnetic resonance cholangiopancreatography: a meta-analysis of test performance in suspected biliary disease. Ann Intern Med 139: 547–557
Green RM and Flamm S (2002) AGA technical review on the evaluation of liver chemistry tests. Gastroenterology 123: 1367–1384
Gronroos JM et al. (2001) A non-icteric cholecystectomized patient with recurrent attacks of right epigastric pain and dilated common bile duct—do liver function tests predict bile duct stones? Clin Chem Lab Med 39: 35–37
Mossberg SM et al. (1962) Serum enzyme activities following morphine. A study of transaminase and alkaline phosphatase levels in normal persons and those with gallbladder disease. Arch Intern Med 109: 429–437
Mann FC (1924) The relation of the gall bladder to the development of jaundice following obstruction of the common bile duct. J Lab Clin Med 10: 540–543
Nathwani RA et al. (2005) Marked elevation in serum transaminases: an atypical presentation of choledocholithiasis. Am J Gastroenterol 100: 295–298
Fortson WC et al. (1985) Marked elevation of serum transaminase activity associated with extrahepatic biliary tract disease. J Clin Gastroenterol 7: 502–505
Mutignani M et al. (2004) Therapeutic biliary endoscopy. Endoscopy 36: 147–159
Acknowledgements
The authors acknowledge the contribution of Dr Irving Waxman who performed the endoscopic retrograde cholangiopancreatography.
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Keswani, R., Hart, J. & Mohanty, S. A patient with abdominal pain and markedly elevated transaminase levels after cholecystectomy. Nat Rev Gastroenterol Hepatol 3, 468–472 (2006). https://doi.org/10.1038/ncpgasthep0556
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DOI: https://doi.org/10.1038/ncpgasthep0556