Dr Mohinder Singh's blog

13.6.24

A 65 years old female (Labh Kaur c/o Gurmukh Singh, ex employee RHP) presented with pain in the upper abdomen and fever for the last 15 days, and a tender palpable gallbladder. Her TLC was 16800 with 82% neutrophils. Recovered with antibiotics. LFTs were within normal limits. US and CT showed a dilated gallbladder and dilated EHBD system with CBD of 20 mm diameter, with circumferential thickening of its wall. The CT also reported a narrow intrapancreatic CBD. Suspecting an obstructive pathology (Ca head of pancreas), she was referred to PGI where she was investigated extensively. The pancreas did not have any tumor, and the CA 19.9 was 5.2 (within normal limits). The MRCP reported proximally dilated (16 mm diameter) CBD with short segment of tapering at the level of its junction with pancreatic duct. The junction of PD and BD was seen outside the duodenal wall in the head of pancreas, with the formation of a common channel of length 1.8 mm suggesting pancreaticobiliary maljunction. The common channel was also reported to be prominent in caliber (8 mm diameter). Since her symptoms had already resolved with a short course of antibiotics, she was sent home, to be just observed in the future for any recurrence of symptoms.