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Man with episodic abdominal pain and jaundice

Man with episodic abdominal pain and jaundice PATIENT PRESENTATIONA 51‐year‐old man without a past medical history presented to our emergency department with 2 months of intermittent epigastric pain radiating to the back, tan stools, fatigue, and weight loss. He denied current alcohol use. He appeared diffusely jaundiced. His abdomen was soft with mild epigastric tenderness and a negative Murphy sign. Serum analysis showed total bilirubin 13.7, aspartate transaminase 207, alanine transaminase 463, alkaline phosphatase 634, lipase > 4000, elevated carcinoembryonic antigen/carbohydrate antigen 19‐9, and negative hepatitis panel. Imaging included point‐of‐care (POC) ultrasound (Figure 1, Video 1), computed tomography (CT; Figure 2), magnetic resonance imaging (MRI; Figure 3), and endoscopic retrograde cholangiopancreatograph (ERCP; Figure 4).1FIGUREPoint‐of‐care ultrasound: Gallbladder (star), pancreatic duct (arrow), and common bile duct (circle).1VIDEOPoint‐of‐care ultrasound of pancreas revealing double duct sign. Gallbladder (star), pancreatic duct (arrow), and common bile duct (circle).2FIGUREComputed tomography abdomen and pelvis: Gallbladder (star), pancreatic duct (arrow), and common bile duct (circle).3FIGUREMRI: Gallbladder (star), pancreatic duct (arrow), and common bile duct (circle) without revealing mass/stone. Abbreviation: MRI, magnetic resonance imaging.4FIGUREEndoscopic retrograde cholangiopancreatography: Duodenum ulcer.DIAGNOSISDouble duct signOur patient had obstructive jaundice. POC ultrasound revealed a distended gallbladder with sludge without signs of acute cholecystitis. The dilated common bile duct >10 mm (normal < 6 mm) and dilated pancreatic duct >5 mm (normal < 3 mm) were consistent with the rare http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of the American College of Emergency Physicians Open Wiley

Man with episodic abdominal pain and jaundice

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References (10)

Publisher
Wiley
Copyright
© 2023 American College of Emergency Physicians.
eISSN
2688-1152
DOI
10.1002/emp2.12929
Publisher site
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Abstract

PATIENT PRESENTATIONA 51‐year‐old man without a past medical history presented to our emergency department with 2 months of intermittent epigastric pain radiating to the back, tan stools, fatigue, and weight loss. He denied current alcohol use. He appeared diffusely jaundiced. His abdomen was soft with mild epigastric tenderness and a negative Murphy sign. Serum analysis showed total bilirubin 13.7, aspartate transaminase 207, alanine transaminase 463, alkaline phosphatase 634, lipase > 4000, elevated carcinoembryonic antigen/carbohydrate antigen 19‐9, and negative hepatitis panel. Imaging included point‐of‐care (POC) ultrasound (Figure 1, Video 1), computed tomography (CT; Figure 2), magnetic resonance imaging (MRI; Figure 3), and endoscopic retrograde cholangiopancreatograph (ERCP; Figure 4).1FIGUREPoint‐of‐care ultrasound: Gallbladder (star), pancreatic duct (arrow), and common bile duct (circle).1VIDEOPoint‐of‐care ultrasound of pancreas revealing double duct sign. Gallbladder (star), pancreatic duct (arrow), and common bile duct (circle).2FIGUREComputed tomography abdomen and pelvis: Gallbladder (star), pancreatic duct (arrow), and common bile duct (circle).3FIGUREMRI: Gallbladder (star), pancreatic duct (arrow), and common bile duct (circle) without revealing mass/stone. Abbreviation: MRI, magnetic resonance imaging.4FIGUREEndoscopic retrograde cholangiopancreatography: Duodenum ulcer.DIAGNOSISDouble duct signOur patient had obstructive jaundice. POC ultrasound revealed a distended gallbladder with sludge without signs of acute cholecystitis. The dilated common bile duct >10 mm (normal < 6 mm) and dilated pancreatic duct >5 mm (normal < 3 mm) were consistent with the rare

Journal

Journal of the American College of Emergency Physicians Open – Wiley

Published: Apr 1, 2023

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