Presentation
Cholecystectomy 20 years ago. Now jaundiced.
Patient Data
Mild dilatation of the intrahepatic ducts with evidently dilated CBD, measuring 15 mm in calibre. The CBD and cystic stump harbour multiple stones, the largest measures 7 mm. Clear cholecystectomy bed. The pancreatic duct is not dilated.
Case Discussion
MRCP shows evidence of common bile duct and cystic stump stones with dilatation of the intra-hepatic biliary radicles. Biliary stones in a postcholecystectomy patient can be residual stones or de novo formed. The remote history of cholecystectomy (20 years), in this case, suggests de novo formation of biliary stones in both the common bile and cystic ducts. Cystic duct stump can harbour stones causing symptoms in post cholecystectomy patients.
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