2017-09-19 16:18:55 UTC

Image Challenge: An Unusual Cause of Biliary Colic

Sept. 19, 2017

What causes episodes of biliary colic in a patient with a normal gallbladder and dilated common bile duct with no stones seen?

Gastroenterology Clinical Image Challenge: A 30-year-old woman presented with recurrent episodes of biliary colic for last three months. There was no history of fever, yellowish discoloration of eyes or urine, and weight loss. Clinical examination was normal. Laboratory investigations revealed the following: total leukocyte count, 6900/L; serum bilirubin, 2.0 mg/dL (normal, 0.2–1.0); aspartate aminotransferase, 87 U/L (normal, 5–50); alanine aminotransferase, 95 U/L (normal, 0–50); serum alkaline phosphatase, 220 U/L (normal, 25–125); serum amylase, 24 U (normal, 20–80); and serum lipase, 32 U/L (normal, 0–190). Abdominal ultrasonography (USG) demonstrated a normal gallbladder (GB) and dilated common bile duct (8 mm) with no stones seen. A linear endoscopic ultrasonography (EUS) was performed (Figure).

What is the diagnosis?

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