2017-11-01 20:04:04 UTC

Image Challenge: Double-Bubble Sign in an Adult Patient

Nov. 1, 2017

What causes intermittent epigastric pain and vomiting in patient with history of cholelithiasis?

Gastroenterology Clinical Image Challenge: A 64-year-old man with a history of cholelithiasis presented to the emergency department with intermittent epigastric pain followed by postprandial vomiting for two days. The patient began to have acute epigastric pain two days ago, which was described as dull, nonradiating and occurring after meals. The pain usually lasted a few hours and resolved spontaneously. During the night before admission, he started to vomit anything he ate. The vomitus was nonbloody, nonbilious and composed of undigested food. On examination, his temperature was 36.7°C and vital signs were stable. The abdomen was flat and soft with normal bowel sounds, but there was a mild tenderness in the epigastrium. Laboratory tests showed neutrophilic leukocytosis (a white blood cell count of 12,500 cells/μL with 72 percent segmented neutrophils) and elevated levels of blood glucose (141 mg/dL), total bilirubin (1.4 mg/dL), and gamma-glutamyl transferase (72 IU/L). The plain film of the abdomen revealed a branching radiolucency in the liver, a nearby spherical calcification, and an air–fluid level represents a “double-bubble sign.”

What is the finding of the plain abdominal film?

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