A Case of Remnant Cholecystitis with an Endoscopically Achieved Definitive Diagnosis

Remnant cholecystitis caused by cystic duct stones is a rare cause of post-cholecystectomy syndrome and it is often difficult to diagnose. We report the case of a man in his seventies with recurrent epigastric pain one year after laparoscopic cholecystectomy. Computed tomography revealed a 10-mm cystic duct stone. Endoscopic retrograde cholangiography (ERC) demonstrated macroscopic purulent bile from the remnant cystic duct, whereas bile from the common bile duct was grossly normal. This confirmed the diagnosis of localized remnant cholecystitis, without the need for cholangioscopy. ERC-guided drainage and subsequent stone removal resulted in a complete recovery. To the best of our knowledge, this is the first report demonstrating macroscopic bile differentiation and successful treatment with ERC-alone.