Blind Spot

A 55-Year-old addiction with severe abdominal pain help in the emergency room of the University hospital in Minneapolis. Stomach ache is unfortunately nothing New: For more than 20 years, she has always such a pain. But now it is worse than ever.

The woman can call the Doctors the reason for their complaints: she suffers from acute intermittent porphyria, an inborn error of metabolism. With this diagnosis, she lives for a good two decades.

Always stomach-ache

The disorder can trigger irregular intervals, abdominal pain. Affected then usually suffer from Nausea, vomiting, and constipation. As typical neurological consequences. For example, Diseased, seizures, or paralysis suffer, the latter can also the respiratory muscles to meet. Then the disease can even lead to death.

The 55-Year-old seems to have in this respect been lucky, so far, no neurological problems are known. However, her abdominal pain was sometimes so strong that she lost consciousness. However, it was not because of these complaints in the hospital since she received the diagnosis.

In the next two weeks is a total of three times in the clinic. You will receive painkillers, medicines against Nausea, and you will be administered intravenous fluid. After she recovers.

Unusual Blood Values

During your last visit to the clinic unusual blood values fall on the Physicians, however, as they report in the “American Journal of Medicine”. The values of certain liver enzymes are elevated, as well as the amount of the so-called Bilirubin, a Bile pigment. In addition, the patient now reports pain, which are slightly more up in the abdomen on the right side. This makes the physician suspicious.

The Doctors perform an ultrasound and discover gallstones and enlarged bile duct. Examine the gall bladder, then using a special method, the endoscope ERCP table retrograde cholangiopancreatography pankreatiko RT short. Here, you push a probe, an endoscope, through the mouth, through the stomach into the duodenum and inject contrast medium into the opening into the bile duct. Then the Physicians to produce x-ray images of the gallbladder, whose structures are highlighted using the contrast agent.

In fact, gallstones stuck in the major bile duct. The Fund declares Year the complaints of the 55-and – your recurrent abdominal pain as the values of the least eye-catching blood. For safety, the Doctors check a urine sample, which gives the patient is in a pain phase. A value that should be in the case of an acute porphyria-thrust striking, is with her in the normal range.

Now it is clear: The woman has no porphyria, but gallstones.

Surgeons remove the gall bladder of the patient, what is in the case of recurring problems with gallstones are a useful measure. Then the woman recovered without further incident.

The Team of Donna Coetzee reported to be the case, because it wants to point out how treacherous it can be, because of an already established diagnosis is not to think about that anymore, that no other disease can explain the complaints of a patient.