Recurrent choledocholithiasis following cholecystectomy, sphincterotomy and choledochoduodenostomy: successful treatment with chenodeoxycholic acid.

An elderly woman presented with recurrent choledocholithiasis. She had had three prior surgical procedures on the biliary tract, including a cholecystectomy with common duct exploration, a second common duct exploration with choledocholithotomy and sphincteroplasty, and subsequently a third common duct exploration with choledochoenterostomy. She refused further surgical therapy and chenodeoxycholic acid therapy was instituted. Within six months, there was partial dissolution of the gallstones. One year later, the stones were not longer demonstrable, and the patient was symptom-free. The potential role of chenodeoxycholic acid therapy, endoscopic papillotomy and postoperative extraction of common duct stones via the T-tube tract, using a Dormia basket, as alternates to surgical therapy of recurrent or retained gallstones are discussed.