Abdominal Pain in a Young Man

Abstract

A 29-year-old man presented to the gastroenterology department, Bulent Ecevit University Hospital, with one week history of continous abdominal pain in the epigastric and right upper quadrant of the abdomen. The pain was unrelated to food consumption, and there was accompanying nausea but no vomiting. His past medical history was uneventful. On physical examination, the patient was alert and oriented. His temperature was 36.7oC, he had a regular pulse which measured 78 beats/min, and his blood pressure was 120/70mmHg. There was epigastric tenderness on deep palpation. There was no guarding and no rebound tenderness. His respiratory and cardiovascular system examinations were normal. Laboratory investigations revealed: C-reactive protein 13.2mg/L (0–8mg/L normal), serum alanine transaminase 378U/L (10–49U/L normal), serum aspartate aminotransferase 405U/L (120–246U/L normal), serum gamma-glutamyl transpeptidase 591U/L (0–73U/L normal), serum lactate dehydrogenase 348U/L (120–246U/L normal), serum alkaline phosphatase 158IU (80–280IU normal), total biluribin 2.0mg/dL (0.3–1.2mg/dL normal), amylase 32U/L (30–118U/L normal), and lipase 24U/L (6–51 U/L normal). The results of a complete blood count, electrolyte panel, and renal function tests were normal. An abdominal ultrasonography showed a well-demarcated anechoic cystic lesion, 75mm in diameter with multiple septations in the left liver lobe. Magnetic resonance imaging and magnetic resonance cholangiopancreatography were also performed [Figure 1 and 2]. Figure 1 Sagittal (a) and axial (b) T2-weighted magnetic resonance imaging revealed hyperintense cystic lesion with hypointense rim in the liver. Figure 2 Magnetic resonance cholangiopancreatography revealed cystic lesion and biliary system.