- The standard treatment for gallstone removal is cholecystectomy.
- The risk of developing common bile duct stones increases with age from 8%-15% in patients <60 years and up to 60% in elderly patients.
- Only a few cases postcholecystectomy bile duct stones are reported in literature following 10 years of surgery.
An 86-year-old male patient with a medical history of hyperlipidemia presented to the emergency department with abdominal pain. The patient underwent a cholecystectomy 15 years ago. The diagnosis was of primary choledocholithiasis.
According to the patient, he had eaten at a fast food restaurant a day before presenting. After which he had mild, diffuse and constant abdominal pain with nausea. The symptoms worsened a day later which brought him to the emergency. On physical examination the patient’s temperature was 102.3°F, positive urinalysis and leukocytosis with left shift. The test results were also remarkable of hyperbilirubinemia with elevated liver enzymes.
CT scan of the abdomen and pelvis were remarkable of dilated intrahepatic and extrahepatic biliary ducts. The common bile duct measured up to 12 mm. Moreover, multiple hyperdensities particularly at the junction of the right and left hepatic ducts, including to the distal CBD were also present.
The findings were consistent with the diagnosis of choledocholithiasis. In addition, an ERCP confirmed the presence of stones within the bile ducts. During removal of stones pus was also present. Similarly, the pus culture confirmed cholangitis. Doctors placed an 10 FR stent placed in the bile duct because of cholangitis.
The patient’s recovery period was unremarkable. He was discharged on antibiotics and asked to come in for a follow-up.
References
Primary Choledocholithiasis 15 Years Postcholecystectomy https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7641679/
