This 76-year-old man is a non-smoker and do not drink. He has histories of peptic ulcer disease, GB stone, and arrhythmia for several years and received medication treatment at local medical center.
One month ago, he suffered from upper abdominal pain with shoulder radiation. Biliary pancreatitis was diagnosed at local hospital with ICU admission. After treatment, he was discharged pain free.
This time, abdominal pain recurred with shoulder and back radiation for 1 day. This episode was similar to previous admission. The pain was dull in nature, aggravated postprandially, but partially relieved after fasting. He denied fever, chills, vomiting, diarrhea, or hematochezia. Thus he was admitted for further survey.
Physical examination revealed epigastric tenderness but no Murphy sign or rebound tenderness. Lab examination revealed AST 289 and ALT 155 but no jaundice or hyperlipasemia.
Mild fecal retenson at sigmoid colon and rectum. Mild local ileus at small intestine. No significant air-fluid level.
Due to epigastric tenderness, we arranged CT for abdomen lesion evaluation.
We followed up liver function few days later and the AST and ALT recovered to normal range. Hepatitis B infection is diagnosed. Due to active ulcers at duodenum without jaundice, ERCP was held. He received proton pump inhibitor treatment for 1 month, but still suffered from intermittent epigastralgia. Thus we followed EGD again
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