Nyeri Epigastrik sebagai Presentasi Awal Kolelitiasis

Abstract

Kolelitiasis sering dijumpai dalam praktek sehari-hari. Selain kolik bilier, kolelitiasis juga dapat menunjukkan gejala atipik berupa dispepsia, sehingga dapat menyebabkan kesalahan diagnosis. Laporan kasus ini bertujuan untuk menjelaskan pentingnya evaluasi sindrom dispepsia dengan diagnosis akhir kolelitiasis. Seorang wanita berusia 33 tahun dirawat dengan keluhan nyeri epigastrik. Pasien didiagnosis dispepsia, namun terapi penghambat pompa proton tidak menghasilkan perbaikan. Pada pemeriksaan fisik ditemukan demam, sklera ikterik, dan nyeri tekan abdomen kuadran kanan atas. Pemeriksaan laboratorium menunjukkan neutrofilia dan hiperbilirubinemia. Pada ultrasonografi (USG) abdomen, ditemukan batu kandung empedu, batu duktus sistikus, dan kolesistitis. Pemeriksaan magnetic resonance cholangiopancreatography (MRCP) menunjukkan adanya batu duktus koledokus. Intervensi berupa endoscopic retrograde cholangiopancreatography (ERCP) disertai ekstraksi batu dan kolesistektomi laparoskopik memperbaiki keluhan nyeri perut. Kolelitiasis perlu dipertimbangkan sebagai diagnosis banding keluhan dispepsia.

Cholelithiasis is often encountered in daily practice. Besides biliary colic, cholelithiasis may show atypical manifestations as dyspepsia. This may lead to misdiagnosis and inappropriate therapy. This case report reemphasized the importance of careful evaluation of dyspepsia. A 33-year-old woman was admitted with epigastric pain. She was diagnosed with dyspepsia, but proton pump inhibitor (PPI) did not result in any improvement. On physical examination, fever, icteric sclera, and right upper quadrant abdominal tenderness were found. Laboratory examination showed neutrophilia and hyperbilirubinemia. An abdominal ultrasound (USG) examination revealed gallbladder stones, cystic duct stones, and cholecystitis. Magnetic resonance cholangiopancreatography (MRCP) examination revealed the presence of stone in the common bile duct. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP) with stone extraction and laparoscopic cholecystectomy. After the procedure, the abdominal pain improved. Cholelithiasis should be considered a differential diagnosis of dyspepsia.