Case 4: A 62-Year-Old Man with Epigastric Pain
This 62-year-old man with a past medical history notable for hypertension, dyslipidemia, and a previous cholecystectomy presents with epigastric pain for the past three days. His bloodwork was notable for an AST of 162, ALT of 581, ALP of 320, and total bilirubin of 43. On assessment, he appears to be in moderate discomfort but is vitally stable. A CT scan performed in the emergency department reveals the following. What is the underlying cause of his abdominal pain?
Choledocholithiasis ***
On CT, the bile ducts are often
Surgically removed gallbladder will have clips near the cystic duct:
(LITFL)
Mild dilation of the pancreatic duct also seen
Abdominal CT: Biliary system and Pancreas
The patient underwent an ERCP in hospital with sphincterotomy and stone removal, which led to an eventual improvement in his symptoms and normalization of his liver enzymes and bilirubin:
