Abdominal distention and ...

A 51-year-old man presented to the emergency unit with right hypochondriac pain and abdominal distention happening 2 days before. There was no significant medical history. The additional symptoms consisted of fatigue and mild postprandial nausea. Reports showed no vomiting, jaundice, or weight loss. He was febrile with a temperature of 38°C; other vital signs were unremarkable. His abdomen was soft with tenderness noted in the right hypochondriac region; Murphy’s sign was positive. Laboratory tests including AFP, CA19-9, CEA, SGOT, SGPT, bilirubin, transaminases and alkaline phosphatase were within normal limits. White blood cells were increased slightly by about 12,000/mm3. An abdominal ultrasound using Doppler evaluation was conducted. CT scan of the abdomen was obtained.