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November 26, 2018

Image challenge: An unusual biliary “pearl”

What caused this to appear in a 40-year-old man with sustained pain after eating dinner?

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Gastroenterology clinical image challenge: A 40-year-old man was admitted to our hospital with sustained upper abdominal pain after dinner. He denied alcohol intake or taking any prescription or over-the-counter medications. He had undergone a laparoscopic cholecystectomy two years ago. A computed tomography scan demonstrated the acute pancreatitis companied with dilation common bile duct (CBD). Laboratory data revealed abnormal elevation of the serum bilirubin (53 μmol/L) and alanine transaminase (85.7 U/L) levels. Emergency endoscopic retrograde cholangiopancreatography was performed. The cholangiogram showed a spindle-shaped filling defect measuring 7 × 20 mm in the proximal CBD. Then an oval pearl-like material with smooth appearance was extracted by endoscopic retrograde cholangiopancreatography.


What is the diagnosis?


To find out the diagnosis, read the full case in Gastroenterology or download our Clinical Image Challenge app through AGA App Central, which features new cases each week. Sort and filter by organ, most popular or favorites. AGA App Central is available in both the Apple App Store and Google Play.


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