Case 32

 A seventy five-year-old male came to our hospital suffering from epigastric to lower abdominal pain initiated from last evening. At admission, tenderness and muscle defense of right lateral to lower abdomen, and mild fever of 37.5 centigrade were found. Laboratory test revealed white blood cells 10600/mm³, neutrophils 73.9 % and CRP 5.19 mg/dL. Abdominal CT showed the swollen appendix with slight elevation of density in the surrounding fat tissue which indicated acute appendicitis and focal peritonitis (Fig.1,2). The patient received intra-peritoneal endoscopic appendectomy at that day. Post-operative process was satisfactory.
 Five days later, vomiting occurred after dining, and fever and upper abdominal pain were found. Laboratory test; white blood cells 8690 /mm³; neutrophils 82.1 %; CRP 1.08 mg/dL; amylase 1171 IU/L (40-132); lipase 1504 IU/L (11-531); AST 55 U/L (12-36); ALT 71 U/L (6-43); ALP 272 U/L (100-340);γGTP 142 U/L (11－64); Total bilirubin 0.60 mg/dL. Abdominal CT showed high density of bile sludge emerging in the gallbladder (Figs. 2, 3).

What caused bile sludge like microlithiasis in gall bladder associated with pancreatitis ?

1. Biliary tract infection

2. Hyperalimentation

3. Rapid weight loss

4. Hyperthyroidism

5. Ceftriaxon infusion

answer

2016.11.16