History A 44-year-old woman presented to the emergency department with a 1-day history of constant abdominal pain and vomiting. The pain came on suddenly, shortly after eating her evening meal. This was followed by intermittent bouts of bilious vomiting. She has diabetes and is concerned about her blood sugars as she has not been able to eat a normal diet since the pain started. Her bowels have opened normally, and she has no urinary symptoms. Examination The patient is febrile with a temperature of 38°C and a pulse rate of 116/min.
She is not clinically jaundiced. On examination of the abdomen, she has tenderness in the right upper quadrant, which is worsened by placing two fingers beneath the tip of the ninth costal cartilage during inspiration. A tender mass is palpable in the right upper quadrant. The urine is clear and rectal examination is normal. What is the most likely…
