Choledocholithiasis

Case contributed by Pranav Sharma

Presentation

Jaundice

Patient Data

Age: 60 year-old
Gender: Male

CT Abdomen

CT

Cholelithiasis and choledocholithiasis with marked intra and extra hepatic duct
dilatation.  There are no pathologically enlarged lymph nodes in the abdomen or pelvis

MRCP

MRI

Gallstones and choledocholithiasis with large stones in the duct and marked intrahepatic duct distension. No features of malignancy.
 

Case Discussion

Longstanding choledocholithiasis with large common bile duct stones and multiple cystic duct stones. Presented to Emergency with new jaundice with bilirubin of 247. No signs of cholangitis.

Underwent a laparoscopic cholecystectomy + operative choledochoscopy +  choledochotomy + stone removal.

Intra-operative findings:

  • Significantly dilated common duct
  • Chronic inflammatory adhesions within hepatocystic triangle
  • Multiple stones retrieved from common bile duct via laparoscopic supraduodenal choledochotomy
  • Multiple cystic duct stones retrieved via incision and direct extraction, and subsequent choledochoscopy
  • Further impacted stone in ampulla retrieved via choledochoscopy
  • Completion choledochoscopy achieved, withdrawal from duodenum with no stones seen
  • IOC performed prior to choledoscopy - no leak from choledochotomy repair site

Histopathology:

  • Sections show mild chronic cholecystitis and fibrosis. No evidence of dysplasia or malignancy.

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