title: Chronic biliary colic associated with ketamine abuse.
abstract: BACKGROUND
  Biliary colic is a common clinical presentation, with the majority of cases being related to gallstone disease. However, rarely, patients may present with biliary symptoms without evidence of gallbladder stones - referred to as acalculous gallstone disease. This case report details a rare case of chronic biliary colic associated with ketamine abuse.
  
  
  METHODS
  A 24-year-old Caucasian female presented to the emergency department with a history of intermittent right upper quadrant pain associated with nausea and malaise. She had experienced bouts of similar symptoms three times a year for the past 4 years. Various investigations had been conducted during her multiple admissions, which showed possible dilatation of the common bile duct, with no evidence of gallstones.
  
  
  CONCLUSIONS
  Patients can present with a dilated common bile duct and an acalculous cholecystitis. This requires considerable investigation, with an emphasis on drug history, especially with the current rise of recreational hallucinogenic drug abuse.
authors.affiliation: Department of Surgery, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Nowfal
authors.affiliation: Department of Surgery, Southend University Hospital, Prittlewell Chase, Westcliff-on-Sea, Essex, UK.
authors.forename: Yahya A
authors.initials: YA
authors.lastname: Al-Abed
keywords: acalculous gallstones; biliary disease; gastroenterology; hepatology; ketamine; substance abuse