Surgeons present the case of a 77-year-old patient affected by acute cholecystitis associated with cholecystoduodenal fistula and common bile duct stones. Preoperative ultrasonography showed a distended, edematous gallbladder and pericholecystic fluid. MRCP confirmed a slight dilatation of the biliary tree with images of stones in the distal biliary duct. A cholecystoduodenal fistula was suspected. Four port sites were used; intraoperative transgallbladder cholangiography showed a stone in the distal biliary duct and the presence of the fistula. After stapling of the fistula, a transcystic extraction of common bile duct stones was performed by using a Dormia catheter. Intraoperative transcystic choledoscopy was performed to confirm clearance of the bile duct.
Between 10% to 18% of patients undergoing cholecystectomy for gallstones have common bile duct stones. Treatment options for these stones include pre- or postoperative endoscopy (endoscopic retrograde cholangiopancreatography), open surgery, or laparoscopic bile duct exploration. Laparoscopic cholecystectomy with simultaneous laparoscopic bile duct exploration seems to be as safe and as efficient as endoscopic retrograde cholangiopancreatography, and avoids an extra procedure.
Authors: Giancarlo Basili, MD, Nicola Romano, MD, Dario Pietrasanta, MD, Irene Mosca, MD
Orlando Goletti, MD