What's the Diagnosis? By Dr. Loran Hatch

80 yo M presents to the ED w/ 1 week of intermittent epigastric pain w/ nausea and vomiting. On ED arrival he is febrile and exam shows epigastric tenderness. His labs show a transaminitis with bilirubin 3.3 and lipase >2300. A CT a/p is done and shown below. What's the diagnosis? (scroll down for answer)







Answer: Choledocholithiasis with gallstone pancreatitis and concern for cholangitis

  • Choledocholithiasis = stones within common bile duct
  • In the US, most CBD stones are due to passing gallbladder stones (10-15% of patients w CBD stones have gallstones)
  • Signs/symptoms- epigastric pain/RUQ pain, fever, jaundice  (Charcot's triad)
  • Complications of CBD stones include= gallstone pancreatitis and cholangitis
  • Treatment
    • IVF, broad spectrum antibiotics
    • ERCP to remove stone and decompress bile duct



Attasaranya S, Fogel EL, Lehman GA. Choledocholithiasis, Ascending Cholangitis and Gallstone Pancreatitis. Med Clin North Am. 2008;92(4):925-60.