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Figure it out fridays 



A 42-year-old male with a history of cerebral palsy, learning difficulties and epilepsy was admitted with a 24-h history of nausea, vomiting and abdominal pain. 

Past surgical history: 

-Laparoscopic cholecystectomy with operative cholangiogram 9 years previously 

-Laparotomy and drainage of a pancreatic pseudocyst 16 years previously


On examination: midline laparotomy scar and a distended, tender abdomen.


Lab tests:

Elevated liver function tests:

ALP 285 U/l

ALT 465 U/l

GGT 669 U/l

with a normal bilirubin.


Magnetic resonance cholangiopancreatography done (image above)

What is your diagnosis?

A. Iatrogenic CBD injury

B. Migration of the surgical clip

C. Malignancy

D. Choledocholithiasis

E. Foreign body

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