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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Bibliographic Details
Published in:Journal of medical case reports 2023-07, Vol.17 (1), p.316-316, Article 316
Main Authors: Kamla, Joël Igor, Bang, Guy Aristide, Tochie, Joel Noutakdie, Tchuenkam, Landry Wakheu, Essomba, Arthur Georges
Format: Article
Language:English
Subjects:
Abdomen
Aged
Asymptomatic
Bile ducts
Biliary drainage
Biliary Tract Surgical Procedures
Case Report
Case reports
Cholangitis
Cholecystectomy
Choledocholithiasis
Choledocholithiasis - diagnostic imaging
Choledocholithiasis - surgery
Choledochotomy
Common Bile Duct - diagnostic imaging
Common Bile Duct - surgery
Endoscopy
Female
Gallstones
Humans
Laparoscopy
Laparotomy
Lithiasis - diagnostic imaging
Lithiasis - surgery
Liver
Metronidazole
Pain
Surgery
Surgical outcomes
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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.
ISSN:1752-1947
1752-1947
DOI:10.1186/s13256-023-04052-3