Abstract Biliary colic classically presents with right upper quadrant (RUQ) pain secondary to transient cystic duct obstruction. Atypical pain patterns may delay diagnosis and management. We report a 22-year-old man presenting with recurrent, severe left upper quadrant (LUQ) pain without systemic symptoms. Physical examination demonstrated isolated LUQ tenderness, and laboratory investigations were unremarkable except for mildly elevated C-reactive protein. Contrast-enhanced multidetector computed tomography (MDCT) revealed a distended gallbladder with focal wall thickening (4 mm), minimal pericholecystic fluid, and cystic duct dilation (1.4 cm). A previously documented 8 mm gallstone at the gallbladder neck was no longer visualized, suggesting migration. No biliary ductal dilation or alternative intra-abdominal pathology was identified. Despite the atypical pain location, imaging findings supported biliary colic with early cholecystitis. Laparoscopic cholecystectomy was performed, and histopathology confirmed chronic active cholecystitis with cholelithiasis. The patient’s symptoms resolved completely postoperatively. This case underscores the importance of maintaining clinical suspicion for biliary pathology even in the absence of classical RUQ pain and highlights the role of early cross-sectional imaging in atypical presentations.
Kari et al. (Wed,) studied this question.