2023-12-24 09:30:58
After a sumptuous Christmas dinner, a 79-year-old woman suddenly suffered from severe upper abdominal pain. Diagnostics do not provide a clear result for a long time until doctors make an unusual discovery.
It’s December 24th in an emergency room in the Czech Republic. It’s snowing a little outside and fortunately everything is calm so far. But then a 79-year-old woman is suddenly admitted with severe pain in her right upper abdomen. The woman reports that the pain began shortly following a lavish Christmas dinner with her family. She had also been feeling sick for regarding half an hour.
Biliary colic despite cholecystectomy?
When the doctors asked if something similar had happened before, the patient reported that she had suffered from gallstones several years ago Cholecystectomy to have undergone. So she already knows this pain. But this time it feels different. The 79-year-old’s other previous illnesses include: Atrial fibrillation, arterial hypertension, gastroösophagealer Reflux, chronic gastritis, Diverticulosis, Osteoporosis as well as those treated surgically Breast cancer.
The doctors in the emergency room first take blood samples in order to better assess the situation. But the laboratory results only show a slight increase in AST and Bilirubin, while the other liver function test values are all normal. Since doctors continue to grope in the dark, they hope to be able to use diagnostic imaging to find a decisive clue to the cause of the symptoms. However, both an x-ray and an ultrasound of the abdomen do not reveal any abnormalities. Although the common bile duct measures 9 mm in diameter, this is considered normal following a cholecystectomy.
An uninvited guest
Could a gastroduodenal ulcer be the cause of the patient’s symptoms? To clarify this question, the doctors finally decide on one Esophagogastroduodenoscopy. They make a surprising discovery: in the Papilla vateri a fish bone has got stuck.
They remove them immediately and the patient actually tells them that there was carp for dinner.
Since there are no signs of one Cholangitis the doctors refrain from additional antibiotic treatment. Fortunately, the 79-year-old’s symptoms soon disappeared following the bones were removed and her liver values quickly returned to normal.
Those: Kunovsky et al. / Digestive Diseases / CC BY-NC
Image source: Unsplash / Jed Owen
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