| Abstrakt: |
A 71-year-old lady was admitted with the sudden onset of right upper quadrant pain. It had begun the previous evening, about half an hour following a small meal of pork and beans. Pain was located in the right upper quadrant, was crampy, gradually worsened, and was associated with intermittent vomiting. She received two injections of demerol Pethedine without relief. There was no previous history of fatty food intolerance or jaundice. She had had previous admissions for typical left ureteral colic in 1955 and low back pain in 1960. She was in acute distress and holding her right upper quadrant. On physical examination, there was much voluntary guarding at this site. Rebound and palpation tenderness were elicited in the same area. The bowel sounds were reduced but present. The temperature was 101·4. A W.B.C. was 15,400 with a shift to the left. Urinalysis and rapid amylase were normal, and the alkaline phosphatase was 2·3, the bilirubin 0·4 total. A chest radiograph showed a raised diaphragm with right lower lobe atelectasis. An abdominal film was not diagnostic. An intravenous cholangiogram using 30 ml. of methylglucamine iodipamide (Cholegrafin) in 100 ml. of saline was performed. Serial films and careful tomography provided the radiographic diagnosis of a perforation with collection of contrast material outside the gall-bladder, and a large calculus in the fundus (see Figs. 1 and 2). |
