52-Year-Old Has Black Vomit, Diarrhea Post Routine Procedure

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Background

A 52-year-old woman presents with a 2-week history of severe abdominal pain. One and a half months earlier, she had reported jaundice and right-sided upper abdominal pain and received a diagnosis of biliary obstruction. She underwent endoscopic retrograde cholangiopancreatography (ERCP), which showed no stone impaction.

Two weeks after ERCP, she had a laparoscopic cholecystectomy. An abdominal CT just before the operation revealed a gallbladder studded with stones and no dilation of the common bile duct (Figure 1).

Figure 1.

Two weeks after the cholecystectomy, the patient reported epigastric and right-sided abdominal pain, which was associated with nonbloody vomiting and a high-grade fever that reached 104 °F (40 °C). She had no constipation or melena.

The surgeon prescribed oral antibiotics, and the pain was partially alleviated. Her temperature decreased to 100.04 °F (37.8 °C), but the fever did not subside until the next week and then returned. After 1 week, the patient reported severe bloody diarrhea and severe vomiting of blackish fluid.

She has a history of full vaccination against COVID-19. She is taking oral contraceptive pills, and her menses are regular. She smokes half a pack of cigarettes per day. She has had a mild elevation in her lipid profile, for which she regularly sees a dietitian; however, she doesn't take any lipid medications at this point.

Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Sarah El-Nakeep. Gastro Case Challenge: After Routine Procedure, 52-Year-Old Has Black Vomit, Diarrhea - Medscape - Feb 27, 2023.

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