Giant Choledocholithiasis: A Case Report

Introduction: Large common bile duct stones often pose therapeutic challenges and frequently require surgical exploration. Though endoscopic techniques are the preferred modality of management, they are often unsuccessful in retrieval of larger stones. Here we describe a case report of a giant common bile duct stone and its subsequent management.

Case Report: A 75-year-old male presented with right upper quadrant abdominal pain, and on evaluation he was diagnosed to have a giant common bile duct calculous. After failed endoscopic intervention, the patient subsequently underwent surgical exploration where the stone was extracted and Roux-en-Y hepaticojejunostomy was done.

Discussion: Cholelithiasis and choledocholithiasis are clinical entities commonly referred to gastroenterologists for subsequent management, either endoscopic or surgical intervention. MRCP is the most valuable tool and ERCP is considered the standard of care for choledocholithiasis at present. However, the probability of complete stone clarence is low for large and difficult CBD stones.

Conclusion: Surgical exploration plays an important role in the management of common bile duct stones, especially in larger stones. Although surgery is now limited to patients with endoscopic failure, surgery provides better evacuation rates and decreased morbidity for large common bile duct stones.