Coronal computed tomographic scan of the abdomen. I indicates inferior; S, superior.
Paulo N. Martins, MD, PhD; Manish C.
Varma, MD; Nahel Elias, MD; James F. Markmann, MD, PhD
A 63-year-old man with history of diabetes mellitus and
liver transplantation 2 years prior to admission visited the
hospital with severe abdominal pain, jaundice, and vomiting 2
days after endoscopic retrograde cholangiopancreatography for
investigation of increasingly abnormal liver function test
results. The patient had no history of cardiac disease and
there was no history of fever in the last days prior to
admission. Physical examination revealed diffuse abdominal
tenderness but no rebound tenderness or guarding. Vital signs
were normal except for tachycardia (heart rate, 120 beats/min).
Laboratory test results were remarkable for total bilirubin
level (32.2 mg/dL; to convert to micromoles per liter, multiply
by 17.104) and lactate level (157.7 mg/dL; to convert to
millimoles per liter, multiply by 0.111). Computed tomography
of the abdomen and pelvis was performed (
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