A 48-year-old male patient was admitted to hospital for dull pain in right upper abdominal quadrant. The patient denies nausea, vomiting, diarrhoea, fever and dyspnea. The pain started suddenly 16 hours ago after consumption of 2 hamburgers.
Patient´s history: state after pancreatitis with resection of pancreatic cauda and splenectomy for abscesses ten years ago. The patient smokes 20 cigarettes and drinks five beers per day. He negates other illnesses. He had not undergone recommended vaccination (due to splenectomy) for years.
He was eupnoeic, cooperating and well-oriented to time and space. His haemodynamics and breathing were stable. It was difficult to examine the abdomen by palpation. The right epi-mesogastrium was painful by palpation, but signs of peritoneal irritation were not present. Peristalsis could not be heard.
Admission lab tests: leukocytes 22 500, haemoglobin 185 g/l, thrombocytes 115 000, creatinine 1.29 mg/dl, LDH 501 IU/ml (normal value is below 250), AST 211 IU/ml (normal value is below 40), ALT 68 IU/ml (normal value is below 40), GMT 2668 IU/ml (normal value is below 71), ALP 165 IU/ml (normal value is below129), bilirubin – total 2.6 mg/dl (normal value is below 1.1), bilirubin – conjugated 1.4 mg/dl (normal value is below 1.1), lipase 415 IU/ml (normal value is below 60), triglycerides 1223 mg/dl (normal value is below 200), CRP 36,4 mg/l (normal value is below 5), urine – sediment and biochemical analysis – physiological values.
Ultrasonography was performed: