Obstructive lithiasis of the lower bile duct discovered four decades after cholecystectomy and its management by ideal choledochotomy: a case report

Residual lithiasis is the presence of stones in the common bile duct, ignored after one or more biliary interventions. We report an atypical case of chronic symptomatic lithiasis of the lower bile duct occurring 41 years after biliary surgery, managed successfully by ideal choledochotomy. A 68-year-...

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Published inJournal of medical case reports Vol. 17; no. 1; p. 316
Main Authors Kamla, Joël Igor, Bang, Guy Aristide, Tochie, Joel Noutakdie, Tchuenkam, Landry Wakheu, Essomba, Arthur Georges
Format Journal Article
LanguageEnglish
Published England BioMed Central Ltd 24.07.2023
BioMed Central
BMC
Subjects
Abdomen
Asymptomatic
Bile ducts
Biliary drainage
Case Report
Case reports
Cholangitis
Cholecystectomy
Choledocholithiasis
Choledochotomy
Endoscopy
Gallstones
Laparoscopy
Laparotomy
Liver
Metronidazole
Pain
Surgery
Surgical outcomes
Africa
Choledochotomy
Biliary drainage
Laparotomy
Choledocholithiasis
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Summary:Residual lithiasis is the presence of stones in the common bile duct, ignored after one or more biliary interventions. We report an atypical case of chronic symptomatic lithiasis of the lower bile duct occurring 41 years after biliary surgery, managed successfully by ideal choledochotomy. A 68-year-old Black African female with several past laparotomies including a cholecystectomy forty-one years ago presented with hepatic colic-type pain that had been intermittent for several years but worsened recently. Her clinical, biological, and imaging test assessments were suggestive of a residual obstructive lithiasis of the lower common bile duct. Through an open right subcostal laparotomy approach, a dilated bile duct of approximately 3 cm was found and managed by transverse choledochotomy in which the stone was extracted in retrograde manner. After confirmation of disobstruction, a primitive bile duct suture without biliary drainage was performed and a tubular drain was positioned under the liver. The postoperative course was uneventful at follow-up of 30 days. Residual choledocholithiasis can be avoided. We performed an ideal choledochotomy, of which the follow-up was simple.
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ISSN:1752-1947
1752-1947
DOI:10.1186/s13256-023-04052-3