Choledocholithiasis

Case contributed by Dr Ian Bickle

Presentation

Local radiologist noticed a fellow worshipper at his local mosque is jaundiced. Intermittent right upper quadrant pain. Dilated CBD on ultrasound.

Patient Data

Age: 75 years
Gender: Male
mri

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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