Sudden onset epigastric pain. Elevated transaminases and bilirubin.
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The gallbladder appears mildly distended, and the common hepatic and common bile duct diameter are at the upper limit of normal. There is a calcific focus measuring 3mm in the distal common bile duct at the level of the pancreatic head. No further gallstones are identified in the gallbladder. Pancreas appears unremarkable, with no peripancreatic fat stranding seen.
Findings are in keeping with choledocholithiasis.
Choledochlithiasis is a relatively common presentation, and occurs when a gallstone becomes lodged in the extrahepatic bile ducts causing obstruction resulting in pain and abnormal liver function tests.