Older man with chronic right upper quadrant pain and vomiting

A 75-year-old man presented to the emergency department with intermittent right upper quadrant abdominal pain for 6 months and newly onset vomiting for 1 day. Two days prior, he received an abdominal ultrasound showing extensive cholecystolithiasis. Clinical examination showed mild tenderness in the right abdomen without peritonitis. Blood test results revealed moderately elevated inflammatory markers as follows: white blood cell (WBC) count 15.44 g/L and c-reactive protein (CRP)  43.4 mg/L. Liver parameters were within normal range. Bedside ultrasound was performed showing a stone-free gallbladder, non-dilated bile duct (Figure 1, panel A), and distended small bowel (Figure 1, panels B and C). Accordingly, computed tomography (CT) was performed (Figure 2).

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The authors received no financial support for the research, authorship, and/or publication of this article.