Choledocholithiasis - 40 years post cholecystectomy

Case contributed by Bertrand Ng
Diagnosis certain

Presentation

Epigastric pain for 3 days with jaundice and fever. Previous open cholecystectomy 40 years ago. Conjugated bilirubin: 91 umol/L.

Patient Data

Age: 70 years
Gender: Female
This study is a stack
Coronal C+ portal
venous phase
This study is a stack
Axial C+ portal
venous phase
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Info

A severely dilated biliary tree with a common bile duct measuring up to 32 mm in diameter and a high burden of calculi in the common bile duct.

The gallbladder is not visible due to a previous cholecystectomy.

Case Discussion

Choledocholithiasis post-cholecystectomy 40 years ago is a rare occurrence 1,2, even scarce, with such numerous calculi found in the common bile duct. An ERCP was performed, and a biliary sphincterotomy was done. A complete calculi removal was subsequently achieved by balloon extraction. A cholangiogram at the end of the procedure confirmed a clear duct.

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