A 59-year-old woman was admitted in October 2009 for presenting jaundice, abdominal pain, vomiting and fever of 38.5oC for one month.
The patient had a history of cholecystectomy for multiple cholelithiasis, and cholecystectomy for intraoral calculi removal 24 years ago.
The common bile duct was closed over a Kher tube with non-absorbable nylon 4/0.
Analytical data included bilirubin 3.9 mg/dl, FA 525 U/l (40-129), GGTP 1313 U/l (8-61), GOT 377 U/l (6SG-38), GGTP 53 mm
Abdominal ultrasound showed moderate dilation of the main bile duct.
Magnetic resonance cholangiography revealed a 13 mm diameter choledochal with a tubular image of 30 x 5 mm inside the hyperintense nucleus that did not leave the sound.
An ERCP showed an intracavitary defect of 30 x 5 mm. After sphincterotomy, Fogarty's balloon was inserted and several microcalciums were extracted.
The cystic was then canalized and the balloon was again passed without obtaining material.
For the second time, the main bile duct was channeled and the Dormia basket was established.
A 3 cm long biliary tree was extracted.
The pathology report corresponded to suture thread together with biliary detritus.
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Follow-up MRI after therapeutic ERCP revealed no pathological findings in the common bile duct.
The patient had a pancreatic reaction with amylasemia of 317 U/l (10-125) which was resolved with fluid therapy, analgesics and antibiotics (ertapenem).
At discharge and several weeks later, the patient was pain free and liver function tests had normalized.
