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Endgames Case Review

Abdominal pain after surgery

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1481 (Published 06 April 2017) Cite this as: BMJ 2017;357:j1481
  1. Zishan Sheikh, ST3 radiology1,
  2. Mehtab Ahmad, assistant professor, radio diagnosis2,
  3. Arvind Pallan, consultant radiologist3
  1. 1Birmingham Children’s Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, UK
  2. 2Aligarh Muslim University Faculty of Medicine, Aligarh, Uttar Pradesh, India
  3. 3Queen Elizabeth Hospital, Birmingham, UK
  1. Correspondence to Z Sheikh zishansheikh{at}hotmail.com

A 24 year old woman presented with acute upper right abdominal pain radiating to the ipsilateral shoulder tip. She had undergone a laparoscopic cholecystectomy four days earlier without immediate complication. There was no other history of previous surgery.

Initial observations showed she was tachycardic with normal blood pressure and low grade pyrexia. On examination she was tender in the epigastrium and upper right quadrant, with no signs of peritonism. There were no other notable examination findings.

Her blood tests showed mildly raised liver transaminases and raised inflammatory markers, including a C reactive protein of greater than 200 mg/L. Urinalysis was unremarkable.

A magnetic resonance pancreatocholangiogram was obtained for further evaluation (fig 1). This showed an area of abnormal T2 hyperintense (bright) signal above the right lobe of the liver that was tracking under the right hepatic margin.

Fig 1 T2 weighted coronal slice from magnetic resonance pancreatocholangiogram showing high signal around the liver, similar to the gastric contents (*)

Questions

  • 1 What postoperative complication has occurred?

  • 2. What other relevant finding is seen on this magnetic resonance pancreatocholangiogram?

  • 3 What other postoperative complications …

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