Phrygian cap cholecystitis

Abstract

A 60-year-old man presented with a 1-day history of worsening colicky right upper quadrant pain. He had nausea without vomiting and was otherwise systemically well. He had no past medical history and took no regular medications. His vital signs were within normal limits. His abdomen was diffusely tender with voluntary guarding and maximal intensity in the right upper quadrant. Murphy's sign was negative. His white cell count was within normal limits at 9 x 109/L, lipase was not elevated at 35 U/L, and liver function tests were unremarkable with bilirubin of 13 μmol/L, gamma glutamyl transferase of 44 U/L, alkaline phosphatase of 54 U/L, alanine aminotransferase of 24 U/L, and aspartate aminotransferase of 31 U/L.