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A 63-year-old woman presented with a 2-day history of fever, abdominal pain, and vomiting. There was no history of previous episodes. Physical examination revealed fever and moderate abdominal tenderness in the right upper quadrant, without jaundice. The white-cell count was 9100 per cubic millimeter, with a normal neutrophil count but 29% band forms. The bilirubin, alkaline phosphatase, aspartate aminotransferase, and alanine aminotransferase levels were normal. Computed tomography of the abdomen revealed multiple stones in the intrahepatic and common bile ducts (asterisks) with diffuse dilatation of the biliary tract (arrows). The stones were not amenable to endoscopic removal; therefore, endoscopic nasobiliary . . . [Full Text of this Article] |
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