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Images of the Month Am J Gastroenterol 2015;110:15; doi:10.1038/ajg.2014.413

A rare cause of obstructive jaundice in a postpartum woman. A 35-year-old woman was admitted to our emergency department with a 2-week history of fever, abdominal pain, and icterus. She had had a normal vaginal delivery 1 month previously. A clinical diagnosis of cholangitis was considered. Serum biochemistry revealed an obstructive situation with raised alkaline phosphatase (550 IU) and direct bilirubin (5.5 mg/dl). Abdominal ultrasonography showed choledocholithiasis. Cholangiogram during endoscopic retrograde cholangiopancreatography revealed dilatation of the common bile duct with an oval filling defect at the lower end suggestive of a calculus. In addition, there was a linear filling defect oriented along the axis of the common bile duct (left). Following papillotomy, a coiled white shiny structure could be seen just at the ampulla (middle). Extraction revealed it to be a roundworm (right). (Submitted by Pankaj Gupta, Saroj Kant Sinha, Rakesh Kochhar, and Uma Debi, Post-Graduate Institute of Medical Education and Research, Chandigarh, India.)

Gastric metastasis of renal clear cell carcinoma. A 76-year-old woman had been diagnosed with primary renal clear cell carcinoma of the left kidney seven years previously. At that time, she underwent a left radical nephrectomy. The patient recently presented to our institution with acute-onset melena and anemia. On physical exam, she appeared well, and her abdomen was soft, nontender, and without any appreciable masses. An esophagogastroduodenoscopy was performed for a suspected upper gastrointestinal bleed. A 5-cm proximal gastric polypoid mass was found in the cardia of the stomach (left) and biopsied. Pathologic evaluation of the gastric mass revealed malignant cells consisting of clear cytoplasm with prominent nucleoli, which is characteristic of renal clear cell carcinoma (middle). Immunohistochemical staining was strongly positive for CAM 5.2 and vimentin, supporting the diagnosis (right). The patient was referred to the oncology department to discuss treatment options. (Submitted by Jacqueline Forman, Jarred Marshak, Yun-An Tseng, David M. Friedel, and James Grendell, New York.)

© 2015 by the American College of Gastroenterology

The American Journal of Gastroenterology

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Image of the month: A rare cause of obstructive jaundice in a postpartum woman.

Image of the month: A rare cause of obstructive jaundice in a postpartum woman. - PDF Download Free
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