Choledocholithiasis after recent cholecytectomy

Case contributed by Dr Michael P Hartung

Presentation

Persistent RUQ pain 3 weeks after cholecystectomy.

Patient Data

Age: 45
Gender: Female

Multiple rounded, partially calcified filling defects within the common bile duct. Mild prominence of the common bile duct and intrahepatic ducts. Cholecystectomy with minimal soft tissue thickening in the cholecystectomy bed and no discrete fluid collections. No dilation of the main pancreatic duct or findings of acute pancreatitis.

Probable small dropped gallstones along the right hepatic lobe near segment five and segment 6.

Case Discussion

One month prior to surgery, the patient had symptomatic cholelithiasis with hyperbilirubinemia. She was managed with ERCP, sweeping of the common bile duct, sphincterotomy, and temporary common bile duct stent placement. 

One month later, the patient underwent laparoscopic cholecystectomy, leaving the common bile duct stent in place. 

Three weeks following cholecystectomy, the patient underwent removal of the stent, but repeat cholangiogram was not performed. Patient had persistent abdominal pain, and CT was performed showing choledocholithiasis.

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Case information

rID: 60929
Published: 8th Jun 2018
Last edited: 8th Jun 2018
Inclusion in quiz mode: Included

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