Open AccessA rare cause of abdominal pain with fever
Author(s) -
Diana Oliveira,
Catarina Correia,
Flávia Cunha,
Patrícia Dias
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2018-228401
Subject(s) - medicine , chills , abdominal pain , emergency department , physical examination , magnetic resonance cholangiopancreatography , surgery , duodenum , vomiting , ectasia , endoscopic retrograde cholangiopancreatography , radiology , pancreatitis , psychiatry
An 89-year-old man presented to the emergency department with a 1-month history of upper right quadrant pain, worsened in the last 3 days and accompanied by fever and chills. On physical examination, he had scleral icterus and right upper quadrant tenderness. Laboratory findings showed hyperbilirubinemia, elevated liver enzymes and C reactive protein. The patient was admitted, suspecting of an acute cholangitis and started on antibiotics. An upper gastrointestinal endoscopy revealed the presence of a juxtapapillary diverticulum in the second portion of the duodenum, which was confirmed by a magnetic resonance cholangiopancreatography, along with upstream biliary tract ectasia. The imaging findings allowed us to diagnose a Lemmel's syndrome. Due to potential surgical risk, we decided for a conservative approach. The patient had a favourable course and was discharged home.