A 24-year-old woman came to the emergency department with abdominal pain, located in the epigastrium and irradiated to the right hypochondrium, nausea, vomiting and fever of up to 39 oC of two days duration.
Associated with the process.
The patient has no personal or family history of interest, is a smoker of about 5 cigarettes/day and habitual consumer of oral contraceptives.
Physical examination revealed a regular general condition, with cutaneous-mucosal jaundice and pain upon palpation of the right hypochondrium, with positive Murphy's sign. The rest of the examination was normal.
Analytically it shows the following alterations: total bilirubin (BT) 3.76 mg/dL (range 0-1.2 mg/dL); direct bilirubin (BD) 3.5 mg/dL (range 0-0.5 mg/dL; range 10.825 mg/dL); reactive bilirubin (0.45% - 0.75)
Abdominal ultrasound showed an "acalculous bladder wall".
Biliary tract not affected
Pancreas without ultrasound abnormalities".
Clinical and laboratory findings were recorded and admission to follow-up was decided.
During admission, it was decided to perform abdominal MRI and cholangio-MRI to assess the biliary tract, which reports: "biliary tract nonspecific and no evidence of repletion defects.
LOE was 9 mm in segment 8 with uptake and density suggesting hemangioma.
Pancreas and other livers showed no evidence of alterations".
New analytical controls are carried out in which persists a direct bilirubin excess, increased leukocytes and increased CRP with amylase, enzymes associated with stasis and transaminase levels normal.
The patient has a poor general condition, with increased pain despite analgesia and very painful abdomen palpation, with feeling of swelling in the right epigastrium-hypochondrium.
Because of this situation, an abdominal CAT with IV contrast is performed urgently, which is reported as "perivesicular edema without lithiasic images or bile duct dilatation.
Small amount of free fluid in Douglas
No images suggesting perforation or pancreatitis".
Patients clinical worsening and suspicion of seizures were established with urgent cholecystectomy, finding a gallbladder with thickened wall and posterior edema.
The anatomopathological results revealed the presence of a transmural infiltrate, although more intense in the muscular layer by polynuclear leukocytes eosinophils.
After surgery, the patient is asymptomatic and discharged a few days after the intervention.
