A 58-year-old patient with no history of interest was admitted to the hospital for 3 days of epigastric pain, fever, jaundice and choluria.
Blood count showed leukocytosis and left shift.
Abdominal ultrasound showed a gall bladder inhabited by gallstones and dilatation of the intrahepatic and extrahepatic bile ducts.
A computed tomography is performed to confirm dilation of the bile duct. Hyperdense images seem to correspond to gallstones or biliary mud in the distal common bile duct.
The pancreatic area had normal characteristics.
Endoscopic retrograde cholangiolithiasis was suspected and a papilledema of normal appearance and a pancreatic therapeutic pathway were performed.
Sphincterotomy was performed with abundant purulent content.
A Dormia catheter was inserted through calculi, but when the wire was removed, it was enclaved in the bile duct and its endoscopic removal was impossible despite several attempts.
An emergency laparotomy was performed by means of a right subcostal incision, finding a scleroatrophic gallbladder and a fistula stricture.
Cholecystectomized patient underwent cholecystectomy, Dormia catheter extraction through intraoperatory catheterization and cholangiography showed the existence of a calculus enclaved in the papilla.
The calculus was extracted and the fistula and choledochal were closed on a T tube. Postoperative course was uneventful and postoperative cholangiography through the Kehr tube was normal.
