Choledocholithiasis - postcholecystectomy

Case contributed by Dr Mostafa El-Feky

Presentation

Obstructive jaundice. Remote history of cholecystectomy.

Patient Data

Age: 50 years
Gender: Female

Dilated intrahepatic and extrahepatic biliary ducts are seen. The CBD measures 12 mm in maximum diameter, with a 7 mm obstructing stone at its distal pancreatic segment.

Dilated cholecystectomy stump with no stones.

The pancreatic duct is not dilated.

Anatomical configuration of the biliary tree:

  • the cystic duct stump joins the CBD at the anterior aspect of its mid-segment
  • trifurcate biliary hilar branching pattern
  • V-type biliopancreatic junction

Case Discussion

MRCP evidence of combined intrahepatic and extrahepatic biliary ductal dilatation secondary to obstructing stone at it distal end. Dilated cholecystectomy stump with no stones. No suspect ampullary or peri-ampullary masses.

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