Recurrent choledocholithiasis following multiple failed endoscopic retrograde cholangiopancreatographies: a case for...

Choledocholithiasis is often managed with endoscopic retrograde cholangiopancreatography (ERCP) as the gold standard, with indications for surgical intervention being few. In the case of failed ERCP, multiple ERCP procedures or where ERCP is not feasible such as after gastric bypass surgery, choledochoduodenostomy may be considered as an effective intervention. This report discusses a case of an 85-year-old woman who presented with recurrent choledocholithiasis and cholangitis, following multiple failed ERCP procedures. She underwent a laparoscopic choledochoduodenostomy. In the post-operative course, she developed Escherichia coli bacteremia, two peri-splenic collections, and a small bowel obstruction which were all successfully managed. She was discharged after 29 days. Laparoscopic surgical management of recurrent choledocholithiasis is a safe alternative to ERCP. It should be considered in individuals with risk factors for recurrent choledocholithiasis, including elderly patients. Clinical vigilance and a multidisciplinary approach in the elderly are vital for optimal management.