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Editor’s quiz: GI snapshot
Rare cause of obstructive jaundice
  1. Sota Nakagami,
  2. Toshihiro Morita,
  3. Shujiro Yazumi
  1. Department of Gastroenterology and Hepatology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, Osaka, Japan
  1. Correspondence to Dr Toshihiro Morita, Department of Gastroenterology and Hepatology, Medical Research Institute Kitano Hospital, PIIF Tazuke-Kofukai, 2-4-20, Ohgimachi, Kita-ku, Osaka 530-8480, Japan; cmski{at}kuhp.kyoto-u.ac.jp

https://doi.org/10.1136/gutjnl-2023-330496

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    Introduction

    An 85-year-old woman, with a high-grade fever (40°C) and abdominal pain, was referred to our hospital. Blood examination revealed an elevated white blood cell count (25.8×10⁹/L) and elevated levels of C reactive protein (8.54 mg/dL), alanine aminotransferase (95 IU/L), aspartate transaminase (138 IU/L), alkaline phosphatase (804 IU/L), gamma-glutamyl transpeptidase (703 IU/L), and total (5.0 mg/dL) and direct (3.2 mg/dL) bilirubin. Contrast-enhanced CT (CECT) was performed (figure 1).

    Figure 1

    (A, B) Axial view of the contrast-enhanced CT. (C and D) Coronal view of the CECT. CECT showing massive paraesophageal hernia, with prolapse of the stomach, duodenum (white arrow), and pancreatic head (yellow arrow), with bile duct stenosis (red arrow).

    Question

    What is the diagnosis?

    Answer

    CECT revealed …

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    Footnotes

    • Contributors SN wrote the manuscript. TM and SY reviewed the manuscript. All authors approved the final version of the manuscript to be published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.