Recurrent abdominal pain: Is an accessory culpable?

A case of abdominal pain leads to an unexpected imaging finding. But is it to blame for the pain?
Ilona Mulvey

Sandra, a 41-year-old female, presents to her GP clinic with a three-week history of recurrent upper abdominal pain. The pain is variable in intensity, at worst 4-5/10 severity and experienced mainly in the right upper abdomen, with radiation to the right shoulder and left upper abdomen.

She denies any accompanying nausea, vomiting, diarrhoea or change in bowel habits, but has noticed some ‘swelling’ in the left upper quadrant. There are no associated systemic symptoms and no past medical history of note.