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Published on: February 28, 2025
A case report of choledocholithiasis 33 years after cholecystectomy
Xane Peters1, Bhargava Gannavarapu2, Antonio Gangemi3
1College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Insights
Choledocholithiasis, or common bile duct stones, after gallbladder removal (cholecystectomy) is rare. This case reports a unique 33-year latency period, highlighting potential causes like surgical clip migration.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Choledocholithiasis post-cholecystectomy is uncommon.
- Often linked to surgical clip migration and nidus formation.
Purpose of the Study:
- To present a rare case of choledocholithiasis with an exceptionally long latency period after cholecystectomy.
- To discuss potential etiologies for delayed common bile duct stone formation.
Main Methods:
- Case report detailing a patient with right upper quadrant pain.
- Diagnostic imaging included abdominal-pelvic CT and Endoscopic Retrograde Cholangiopancreatography (ERCP).
- Intervention involved biliary sphincterotomy and stone fragment removal.
Main Results:
- Choledocholithiasis diagnosed 33 years after cholecystectomy.
- Findings included a dilated common bile duct, long cystic duct remnant, and surgical clips.
- Successful removal of sludge and stone fragments from the biliary tree.
Conclusions:
- This represents the longest reported latency period for choledocholithiasis post-cholecystectomy in a patient without duodenal diverticulum.
- Potential causes include surgical clip migration, remnant cystic duct stones, or primary choledocholithiasis.
- Highlights the importance of considering delayed complications after cholecystectomy.
Introduction:
Choledocholithiasis after cholecystectomy is rare and often attributed to surgical clip migration and subsequent nidus formation.
Presentation Of Case:
This case demonstrates choledocholithiasis following cholecystectomy with a latency period of 33 years.
Discussion:
The patient presented with pain of the right upper quadrant (RUQ). Subsequent abdominal-pelvic CT imaging revealed dilation of the common bile duct. Further Endoscopic Retrograde Cholangiopancreatography was indicative of choledocholithiasis. Additional findings included a long cystic duct remnant and surgical clips in the RUQ.
Conclusion:
The patient underwent biliary sphincterotomy and sludge and stone fragments were swept from the biliary tree. To our knowledge, a latency of 33 years between cholecystectomy and choledocholithiasis has never been reported before, at least not in a patient without coexisting duodenal diverticulum, a condition associated with lithiasis of the common bile duct. Our case raises discussion of potential etiologies for such long latency, including surgical clip migration, remnant cystic duct lithiasis, and primary choledocholithiasis; and further details the incidence of such long latency periods following cholecystectomy.
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