Surgical treatment of secondary choledocholithiasis and megacholedochus

Written by Kántor Tibor o.h., Török Árpád, Borz Oliviu, Bancu Şerban

About 15% of people will develop stones in the common bile duct after cholecystectomy, which leads to symptoms that include pain, jaundice and cholangitis. The current study presents the case of a 33 year old patient, with cholecystectomy in the past, who was hospitalized with cholangitis symptoms and obstructive jaundice. Laboratory tests and imaging studies led to surgical treatment. Intraoperatory, a 4 cm dilated CBD was discovered, containing a 2 cm stone. As for surgical care, we performed open choledochotomy and removed the stone. This was followed by intraoperative exploration of the CBD and a biliodigestive anastomosis. The postoperative evolution of the patient was favorable and the symptoms disappeared. The choledocholithiasis formed relatively soon after a cholecystectomy is, in most cases, a complication given by the secondary stones undiscovered during the surgery. For the diagnosis of secondary choledocholithiasis and to avoid a new surgical intervention, the intraoperative ultrasonography, T-tube cholangiography, ERCP and choledochoscopy can be used.


Keywords: choledocholithiasis, cholangitis, choledochotomy, secondary stones

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