Case report of choledocholithiasis 40 years post cholecystectomy

Choledocholithiasis occurring 40 years postcholecystectomy surgery is not commonly seen and is one of the longest reported latency period in literature today. Herein, we report a case of a 72 year old lady with previous open cholecystectomy 40 years ago, presented with acute onset right upper quadrant pain. Her bloods result revealed an obstructive jaundice picture with total bilirubin 125 μmol/L. Computed tomography imaging revealed high burden calculi in the common bile duct. The choledocholithiasis was subsequently completely retrieved by endoscopic retrograde cholangiopancreatography procedure. The commonest causes for delayed presentation of choledocholithiasis is retained or regeneration of stones within a gallbladder remnant or cystic duct with majority of retained stones present within 2-3 years of surgery. Presentation later than that is thought to be secondary to migratory surgical clips as it acts as a nidus for stone formation. There are other studies that revealed common bile duct stones formation to be associated with bile duct stricture, periampullary diverticulum, parasites or foreign bodies within bile duct or other factors that can cause bile stasis. Our aim for this case report is to add to the current handful of cases with such lengthy latency and hopefully this will give rise to future research and to better our understanding of the potential risk factors and causation of this prolonged latency postcholecystectomy.