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An unusual case of biliary pain
  1. J Boujaoude1,
  2. B Abboud2,
  3. M Chemaly3,
  4. K Hachem4,
  5. A Zoughbi5
  1. 1Department of Gastroenterology, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
  2. 2Department of General Surgery, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
  3. 3Department of Gastroenterology, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
  4. 4Department of Radiology, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
  5. 5Department of Emergency, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon
  1. Correspondence to:
    Professor J Boujaoude
    Department of Gastroenterology, Hotel-Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon; jboujhotmail.com

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Clinical presentation

A 62 year old woman presented with a one month history of increasing postprandial epigastric pain radiating through to her back. Her medical history included endoscopic sphincterotomy of the papilla with laparoscopic cholecystectomy two years earlier for biliary lithiasis. Her clinical evaluation was normal. White cell count was 14600/mm3, and liver aminotransferases, serum lipase, and amylase were all normal. A stress test and echocardiography were normal. No abnormalities were found at gastroscopy, on abdominal ultrasound, or after tomography. An endoscopic ultrasound was performed (fig 1). What does it show?

Figure 1

 Endoscopic ultrasound.

Question

What is the differential diagnosis?

See page 1145 for answer

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Footnotes

  • Robin Spiller, editor

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