Recurrent choledocholithiasis with cholangitis 30 years post-cholecystectomy with negative ERCP: a case report

Area of Science:

• Gastroenterology and Hepatology
• Diagnostic Imaging
• Biliary System Disorders

Background:

• Recurrent primary choledocholithiasis is the reoccurrence of bile duct stones, a known complication post-cholecystectomy (CCY).
• While common within 3 years of CCY, recurrence after 30 years is rare.
• This case highlights a patient with recurrent choledocholithiasis and cholangitis despite negative ERCP.

Observation:

• A 64-year-old female presented with cholangitis symptoms despite a recent negative ERCP.
• Blood cultures confirmed gram-negative rod infection, consistent with cholangitis.
• The patient had a history of CCY, recurrent choledocholithiasis, a dilated common bile duct, and multiple prior stone episodes.

Findings:

• The case questions the utility of endoscopic ultrasound (EUS) and magnetic resonance cholangiopancreatography (MRCP) in high-risk choledocholithiasis patients.
• Guidelines suggest direct ERCP for high-risk patients, with EUS/MRCP for intermediate-risk.
• EUS and MRCP can be valuable for pre-ERCP evaluation in complicated recurrent choledocholithiasis cases.

Implications:

• Identifying patient-specific risk factors is crucial for managing and preventing recurrent choledocholithiasis.
• Early detection and localization of stones using EUS or MRCP are recommended in complex recurrent cases.
• Utilizing advanced imaging may prevent further invasive procedures and reduce recurrence risk.