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BMJ 2017; 358 doi: (Published 28 September 2017) Cite this as: BMJ 2017;358:j3811
  1. Toshihiko Takada, assistant professor,
  2. Michio Hayashi, lecturer,
  3. Jun Miyashita, assistant professor,
  4. Teruhisa Azuma, associate professor
  1. Department of general medicine, Shirakawa satellite for teaching and research, Fukushima Medical University, Fukushima, Japan
  1. Correspondence to T Takada ttakada{at}

A 64 year old woman presented with left upper abdominal pain, which was first felt as a “pins and needles” sensation five years earlier and gradually evolved to …

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