A Woman With a Suspected Gallstone

Figure

Clinical presentation

A 94-year-old woman who was generally in good health came to the emergency room complaining of pain in the right upper abdominal quadrant radiating into the right shoulder, of one week’s duration. She had suffered from gallstones for 50 years and had been referred by her primary care physician with the words, “Acute pain, suspected gallstone.” On initial inspection of the unclothed patient, the emergency room physicians noted dermatomally distributed pustules and vesicles on an erythematous ground on the right side of the chest (segments T5 and T6). Severe herpes zoster was diagnosed. Laboratory testing and abdominal ultrasonography yielded no evidence of intra- or extrahepatic cholestasis, although a solitary gallstone was found (15 × 10 mm). The patient was admitted to the dermatology service for intravenous aciclovir treatment and intense topical therapy. The diagnosis of painful conditions can be especially difficult in the elderly; this case underscores the need in this age group (as in all age groups) not only for appropriate history-taking, but also for a physical examination oriented to the patient’s chief complaint.

PD Dr. med. Michael Bernhard, Prof. Dr. med. André Gries Zentrale Notaufnahme, Universitätsklinikum Leipzig, [e-mail]

Conflict of interest statement
The authors declare that no conflict of interest exists.

Cite this as: Bernhard M, Gries A: A woman with a suspected gallstone. Dtsch Arztebl Int 2017; 114: 100. DOI: 10.3238/arztebl.2017.0100

Translated from the original German by Ethan Taub, M.D.