Abdominal Pain in a Young Man

Abstract

A 29-year-old man presented to the gastroenterology department, Bülent Ecevit University Hospital, with one week history of continuous 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. The imaging diagnosis points toward hepatic hydatid cyst with biliary ductal connection. In the presence of biliary connection, surgery is the best choice for hepatic hydatid cyst treatment. The postoperative period was uneventful and he recovered quickly after surgery. Surgical resection of the hydatid cyst was done and during surgical exploration of the wall of the cyst, entry of the bile duct into cystic cavity was seen. After surgical resection, the patient’s abdominal pain subsided and liver functions turned to be normal. The patient was discharged with a prolonged course of albendazole treatment. Hydatid disease is a worldwide zoonosis caused by the Echinococcus’s larva. Liver is the most common site of the hydatid cysts. The hepatic hydatid cysts usually have a hypointense rim on T2-weighted magnetic resonance (MR) images. MR and MRCP are proved to be sensitive and valuable non-invasive diagnostic methods for the diagnosis of intrabiliary rupture or biliary ductal connection of hepatic hydatid disease.

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