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Giant choledochal calculosis: surgical treatment
Hasan Bektas1, Yigit Duzkoylu1, Ekrem Cakar1
1Istanbul Training and Research Hospital, General Surgery Department, İstanbul, Turkey.
North American Journal of Medical Sciences
|December 10, 2014
Summary
Giant common bile duct stones, over 10 mm, pose challenges for endoscopic retrograde cholangiopancreatography (ERCP). This case highlights successful open surgery for a rare, large 15 cm × 4.5 cm choledochal stone.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Biliary Tract Diseases
Background:
- Gallstone disease is a common surgical pathology, with choledocholithiasis (bile duct stones) requiring intervention.
- Endoscopic retrograde cholangiopancreatography (ERCP) is standard for bile duct stones but often fails for stones larger than 10 mm.
Observation:
- A 59-year-old woman presented with a giant common bile duct (CBD) stone measuring 15 cm × 4.5 cm (110 mm × 41 mm).
- Magnetic resonance cholangiopancreatography (MRCP) revealed a hydropic gallbladder and an excessively dilated CBD filled with the stone.
Findings:
- Open surgery was performed, involving choledochotomy, removal of the giant calculus, and T-tube choledochostomy with choledochoduodenostomy (CD).
- The patient recovered without complications and was discharged on postoperative day 8.
Implications:
- Giant CBD stones are rare but can occur without severe symptoms, though jaundice is common.
- While MRCP is useful for detection, open surgery remains a crucial option for large or complex choledocholithiasis when endoscopic methods fail.
