Peters Xane, Gannavarapu Bhargava, Gangemi Antonio
College of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Division of Gastroenterology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
Int J Surg Case Rep. 2017;41:80-82. doi: 10.1016/j.ijscr.2017.09.029. Epub 2017 Oct 12.
Choledocholithiasis after cholecystectomy is rare and often attributed to surgical clip migration and subsequent nidus formation.
This case demonstrates choledocholithiasis following cholecystectomy with a latency period of 33 years.
The patient presented with pain of the right upper quadrant (RUQ). Subsequent abdominal-pelvic CT imaging revealed dilation of the common bile duct. Further Endoscopic Retrograde Cholangiopancreatography was indicative of choledocholithiasis. Additional findings included a long cystic duct remnant and surgical clips in the RUQ.
The patient underwent biliary sphincterotomy and sludge and stone fragments were swept from the biliary tree. To our knowledge, a latency of 33 years between cholecystectomy and choledocholithiasis has never been reported before, at least not in a patient without coexisting duodenal diverticulum, a condition associated with lithiasis of the common bile duct. Our case raises discussion of potential etiologies for such long latency, including surgical clip migration, remnant cystic duct lithiasis, and primary choledocholithiasis; and further details the incidence of such long latency periods following cholecystectomy.
胆囊切除术后胆总管结石较为罕见，通常归因于手术夹移位及随后的结石核心形成。
本病例展示了胆囊切除术后33年潜伏期的胆总管结石。
患者出现右上腹疼痛。随后的腹部盆腔CT成像显示胆总管扩张。进一步的内镜逆行胰胆管造影表明存在胆总管结石。其他发现包括长的胆囊管残余以及右上腹的手术夹。
患者接受了胆管括约肌切开术，胆汁中的淤渣和结石碎片被从胆管树中清除。据我们所知，胆囊切除术与胆总管结石之间33年的潜伏期此前从未有过报道，至少在没有并存十二指肠憩室（一种与胆总管结石相关的病症）的患者中未曾报道过。我们的病例引发了对于这种长潜伏期潜在病因的讨论，包括手术夹移位、残余胆囊管结石以及原发性胆总管结石；并进一步详细说明了胆囊切除术后这种长潜伏期的发生率。
