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Choledocholiathiasis with cholangitis

Case contributed by Siobhan Lee
Diagnosis certain

Presentation

3 days of RUQ pain, nausea and vomiting. 24hrs of lethargy, chills and rigors, dark urine, jaundiced.

Patient Data

Age: 60 years
Gender: Male

CT abdomen demonstrates a 7 mm calculus in the distal common bile duct with mild intra and extrahepatic biliary dilatation, in keeping with obstructive choledocholiathiasis. 

The gallbladder wall is thickened, irregular and enhancing with mild pericholecystic fat stranding, suggestive of cholecystitis. Gallbladder fundus diverticulum noted.

Case Discussion

The patient had presented 5 months earlier with acute cholecystitis. He presented on this occasion with obstructive jaundice - with elevated bilirubin 150, with mildly elevated LFTs (ALP 115 / GGT 229 / ALT 132 / AST 53). He had chills and rigors, although he was afebrile and had normal WCC 6.1. He underwent ERCP the following day, with pus draining following CBD cannulation and successful removal of a 7 mm distal CBD stone. He was managed with IV and oral antibiotics for acute cholangitis, and discharged to await outpatient laparoscopic cholecystectomy.

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