case_images: PMC6701271_01
case_images: Preoperative ERCP demonstrating a significantly dilated intrahepatic biliary tree, external compression of the extrahepatic biliary ducts, and large filling defect of the cystic duct and gall bladder.
case_images: CRIS2019-4615484.001.jpg
case_images: PMC6701271_01_CRIS2019-4615484.001.jpg
case_images: fig1
case_images: However, despite this, there was still tapering in the common hepatic and common bile ducts noted from extrinsic compression from the large stones in the gallbladder and a significant filling defect through the cystic duct (Figure 1).
case_images: Two large gall stones were dissected free from the gallbladder and surrounding structures after a partial cholecystectomy was performed. Each stone measured approximately 3-4 centimeters in diameter.
case_images: CRIS2019-4615484.002.jpg
case_images: PMC6701271_01_CRIS2019-4615484.002.jpg
case_images: fig2
case_images: When removed, the stone measured approximately 3.5 centimeters (Figure 2), and pus and necrotic tissue were found within the gallbladder. Attention was then turned to the neck of the gallbladder where the anterior wall of the gallbladder was again incised, revealing another a large 4-centimeter stone (Figure 2) that was dissected off the posterior wall and removed.
case_images: Free flap of the gallbladder wall after partial cholecystectomy was performed. The luminal surface is demonstrated here with total flap size measuring approximately 4 centimeters in length and 2.5 centimeters in width.
case_images: CRIS2019-4615484.003.jpg
case_images: PMC6701271_01_CRIS2019-4615484.003.jpg
case_images: fig3
case_images: Thus, the decision was made to use a dissected, viable gallbladder wall piece to form a free flap to repair the defect in the biliary tree (Figure 3).
case_images: Postoperative follow-up imaging revealing no intrahepatic biliary dilation and a patent extrahepatic biliary system and stent (top left, clockwise, anterior to posterior).
case_images: CRIS2019-4615484.004.jpg
case_images: PMC6701271_01_CRIS2019-4615484.004.jpg
case_images: fig4
case_images: On a subsequent follow-up, the patient was noted to remain clinically stable and follow-up CT scans revealed no intrahepatic biliary duct dilation, a normal caliber common bile duct, no intraluminal filling defect, a patent stent, and no biliary leak (Figure 4).