A 32-year-old woman was monitored by her gynecologist for severe hypogastric pain.
The initial study identified palliative care services referred to the Emergency Department of the Dávila Clinic for pain management and evaluation by vascular surgeon.
His medical history included cholecystectomy for bariatric disease in 2011 and vertical gastrectomy (= gastric tube) in 2014.
Some laboratory tests were done, particularly liver tests and C-reactive protein were found in normal range.
To control his pain, he received 20 mg of morphine e.v., followed by a sudden change in the clinical picture: hypogastric pain subsided, but then gave rise to an asphyxia of the abdomen radiating.
She received NSAI-s e.v., with only minimal pain improvement.
Abdominal ultrasound was performed, with no significant changes.
Elevated liver enzymes, elevated SGOT and SGPT, with minimal elevation of alkaline phosphatase GGT, were monitored.
She was hospitalized for pain management and observation.
Infectious hepatitis and cholangiolithiasis were ruled out, and bile duct stones were not the least suspected.
Pain subsided after > 6 h of duration, with slow decrease in transaminases, whose normalization took one week.
There was no increase in amylase and/or lipase.
Pulmonary thromboembolism also developed during hospitalization, with good clinical evolution.
With respect to gynecological pathology was diagnosed pelvic congestion syndrome requiring angiographic study and eventual embolization, but due to the need for anticoagulation for pulmonary thromboembolism no further study was performed during hospitalization.
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The patient had never had previous discomfort compatible with this functional disorder, or clinical manifestations of Oddi sphincter dyskinesia.
Consequently, we did not see any indication of performing a manicure of Oddi or biliary sphincterotomy.
The patient was followed up on an outpatient basis 2 months later with all tests in normal range.
He only reported meteorism, occasional swelling, as in previous years, without severe biliary pain.
I was receiving oral anticoagulation.
