Presentation
Jaundice. Intermittent right upper quadrant pain. Dilated CBD on ultrasound.
Patient Data
Innumerable stones in the gallbladder - most of which are less than 5mm, just waiting to 'drop' into the common bile duct.
The distal common bile duct contains at least 20 stones.
Severe intra and extra-hepatic duct dilatation due to obstructing stones.
Case Discussion
When it comes to choledocholithiasis, it doesn't get much better than this - there are so many gallstones they are uncountable.
These little gallstones are dropping off like hailstones into the distal CBD - the accumulation of which has resulted in severe biliary obstruction.
ERCP was performed with stone clearance and a stent place. Interval cholecystectomy is advised as the bag of remaining stones is almost certain to keep discharging stones into the CBD again.
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