title: Cholelithiasis presented as chronic right back pain.
abstract: Chronic right back pain is a symptom in both biliary lithiasis and chronic cholecystitis. Ten percent of the population in the world suffers from biliary lithiasis. Only 20% are symptomatic. The first diagnostic test of choice is an abdominal ultrasound. When a suggestive clinical sign of biliary colic with negative abdominal ultrasound is identified, we should consider the option of carrying out an endoscopic ultrasound in order to rule out microlithiasis. The case discussed in the report presented with chronic right back pain, which is an atypical manifestation of biliary lithiasis and chronic cholecystitis. It is important to know about the atypical manifestations of the prevalent illnesses as well as the limits of the diagnostic tests, in order to avoid diagnostic delays which may cause complications that could worsen a patient's prognosis. This case should contribute to the medical knowledge and must have educational value or highlight the need for a change in clinical practice, especially in primary care.
authors: Department of Primary Care, Catalan Health Institute, Primary Care Center Jaume I, Tarragona, Spain.
authors: Francesc
authors: F
authors: Bobé-Armant
authors: Catalan Health Institute, Primary Care Center Dr. Lluís Sayé, Barcelona, Spain.
authors: Maria Eugenia
authors: ME
authors: Buil-Arasanz
authors: Catalan Health Institute, Josep Trueta Hospital, Surgery Service, Girona, Spain.
authors: Griselda
authors: G
authors: Trubat-Muñoz
authors: Department of Primary Care, Catalan Health Institute, Primary Care Center Jaume I, Tarragona, Spain ; Department of General Pathology, University Rovira i Virgili, Tarragona, Spain.
authors: Carles
authors: C
authors: Llor-Vilà
authors: Catalan Health Institute, Joan XXIII Hospital, Surgery Service, Tarragona, Spain ; Department of Surgery, University Rovira i Virgili, Tarragona, Spain.
authors: Vicente
authors: V
authors: Vicente-Guillen
keywords: Abdominal ultrasound; atypical manifestation; back pain; biliary lithiasis; cholecystitis; cholelithiasis; chronic right back pain; clinical practice; diagnostic test; primary care