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A patient with abdominal pain and markedly elevated transaminase levels after cholecystectomy

Nature Clinical Practice Gastroenterology & Hepatology volume 3, pages 468–472 (2006)Cite this article

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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Figure 1: Liver histology slide of a 33-year-old female with abdominal pain and elevated transaminase levels.

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Acknowledgements

The authors acknowledge the contribution of Dr Irving Waxman who performed the endoscopic retrograde cholangiopancreatography.

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Authors and Affiliations

  1. Clinical Fellow in Gastroenterology,

    Rajesh N Keswani, John Hart & Smruti R Mohanty

  2. Department of Pathology,

    Rajesh N Keswani, John Hart & Smruti R Mohanty

  3. Department of Medicine at the University of Chicago, IL, USA

    Rajesh N Keswani, John Hart & Smruti R Mohanty

Authors
  1. Rajesh N Keswani
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  2. John Hart
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  3. Smruti R Mohanty
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Corresponding author

Correspondence to Rajesh N Keswani.

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The authors declare no competing financial interests.

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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

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