A Rare Cause of Recurrent Abdominal Pain
نویسنده
چکیده
A 30-year-old man presented with a nine-months history of repetitive abdominal pain simulating dyspepsia. Nine months before presentation, a local physician saw him, and he performed upper gastrointestinal endoscopy for him, and was diagnosed as a case of mild gastritis with oral omeprazole, but without any benefit. So the patient was seen at another center and was evaluated by abdominal computerized scan (CT scan) and colonoscopy which both of them were normal. The patient was evaluated and treated also by psychiatrist as a case of functional disease. On admission to our clinic, the patient had complaints of epigastric pain, nausea, and vomiting. Laboratory investigations revealed the following results: aspartate aminotransferase: 37 IU/L, alanine aminotransferase: 24 IU/L, alkaline phosphatase: 67 IU/L, total bilirubin: 1.8 mg/dl, conjugated bilirubin: 1.6 mg/dL, hemoglobin: 13.7 g/dl, white blood cell count: 12.1 K/mm3, platelet count: 297000/mm3 and eosinophil count 0.2%/mm3. Magnetic resonance cholangiopancreatography (MRCP) revealed irregular focal choledochal wall thickening with partial obstruction of the distal choledochus. Endoscopic retrograde cholangiopancreatography (ERCP) was performed due to extrahepatic cholestasis; which was revealed a maximum choledochus diameter of 16 mm, and showed multiple filling defects and irregular choledochal wall margin (Figure A). After endoscopic sphincterotomy and balloon extraction, two live wide objects were forced out through the sphincterotomy site to the duodenal lumen (Figure B). Occlusion cholangiography with a balloon catheter was performed to evaluate for remaining objects in the common bile duct, which showed none. The objects were suctioned through the duodenoscope and sent for pathological evaluation. 1. Liver and Gastrointestinal Diseases Research Centre, Tabriz University of Medical Sciences, Imam Reza hospital, East Azerbaijan, Iran Ali Ghavidel1*
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عنوان ژورنال:
دوره 7 شماره
صفحات -
تاریخ انتشار 2015