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JAMA Surgery Clinical Challenge
December 2013

Abdominal Pain and a Biliary Abnormality

Author Affiliations
  • 1Department of Surgery, Thomas Jefferson University, and Jefferson Pancreas, Biliary, and Related Cancer Center, Philadelphia, Pennsylvania
JAMA Surg. 2013;148(12):1161-1162. doi:10.1001/2013.jamasurg.48

A 30-year-old female immigrant from Laos was referred to our institution after admission to an outside hospital for right upper quadrant abdominal pain with associated nausea and vomiting. Her imaging results from the outside hospital included abdominal magnetic resonance cholangiopancreatography revealing a cystic abnormality in the region of the porta hepatis (Figure 1A). The patient denied any previous medical or surgical history. On examination, the patient had mild right upper quadrant tenderness to palpation without signs of peritonitis. Routine laboratory values were within normal limits, except for a mildly elevated amylase level. A computed tomographic scan was obtained to further delineate the abnormality (Figure 1B).