Ochsner Surgical Case Study

Presentation:

A 52-year-old male was admitted to the hospital with a 3-week history of intermittent epigastric discomfort, fatigue, and nausea. He reported the development of loose, tan-colored stools and dark, tea-colored urine with associated generalized pruritus. In addition, an involuntary 16-pound weight loss was also experienced. The patient's medical history was unremarkable and he denied using any over-the-counter prescription medications. There was no hstory of gall stone disease. The patient had undergone a normal colonoscopic examination 18 months prior to this admission, and there was no history of lower abdominal pain or hematochezia. On admission, the patient was afebrile and physical examination revealed icteric sclera but was otherwise unremarkable. Laboratory evaluation showed hemoglobin, 12.3 gm/dL; albumin, 3.5 gm/dL; total bilirubin, 11.2 mg/dL; direct bilirubin 7.8 mg/dL; alkaline phosphatase, 204 IU/dL; aspartate transaminase,35 IU/dL; and alanine tranaminase 48 IU/dL. Prothrombin time was 13.6, and INR 1.2. Computerized tomography of the abdomen at admission revealed intrahepatic biliary ductal dilatation, proximal common bile duct dilation to 1.2 cm, and gallbladder wall thickening. No mass lesion was identified. A percutaneous transhepatic cholangiogram was performed.