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Rabih M. Salloum, MD; Leonidas Koniaris, MD
From the Department of Surgery, University of Rochester School of Medicine, Rochester, NY.

Arch Surg. 2004;139:449.

	Since this article does not have an abstract, we have provided the first 146 words of the full text and any section headings.

INTRODUCTION

A 75-year-old man with a history of type 2 diabetes mellitus, hypertension, and depression sought care at the emergency department with a 5-day history of generalized itching and malaise. At physical examination, the patient was slightly anxious but in no acute distress; his sclera were icteric, and his abdomen was soft, with slight fullness in the right upper quadrant but no discrete masses or tenderness. Laboratory test results demonstrated a white blood cell count of 13 500 cells per microliter (13.5 x 10^{– 9} L) but his electrolyte level was normal. His total serum bilirubin level was 19.5 mg/dL (333.45 µmol/L), and he had an alkaline phosphatase level of 917 IU/L. A computed tomographic (CT) scan of the abdomen was obtained (Figure 1).

Figure appears in full text version. Figure 1.

What Is the Diagnosis?

A. Complex cystic neoplasm

B. Unusual duplication cysts

C. Periampullary tumor

D. Mirizzi syndrome

SECTION EDITOR: GRACE S. ROZYCKI, MD

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Arch Surg. 2004;139(4):450.
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