Impacted common bile duct stone managed by hepaticoduodenostomy

A bypass procedure such as a hepaticoduodenostomy may be an alternative to the traditional choledochoduodenostomy in the management of the retained, impacted distal common bile duct stone especially in the presence of sepsis. In low-resource settings with lack of fluoroscopy, fibreoptic instruments (choledoscope) or radiologically guided wire baskets or balloons for stone retrieval, there are operative hazards in blindly exploring the common bile duct. We present herein a hepaticoduodenostomy performed for a retained, impacted distal common bile duct stone in a low-resource setting with a good outcome. This impacted stone had complicated an open cholecystectomy for acute cholecystitis by causing the dehiscence of the cystic duct stump as a result of distal biliary obstruction.