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Mentions: A 74-year-old man was admitted to our hospital with a two-month history of intermittent episodes of right upper quadrant abdominal pain without jaundice. Open cholecystectomy had been performed for symptomatic gallstone-associated cholecystitis approximately 15 years earlier. At that time, multiple stones were found in a distended and inflamed gallbladder. Operative cholangiography showed a filling defect in the CBD. Upon exploration the distal CBD had been dissected and subsequently repaired with a proline suture after T-tube insertion. Over the intervening years the patient had remained asymptomatic until 2 months prior to this presentation. On admission, a physical examination revealed the patient to be relatively weak with an area of pain and mild tenderness to palpation in the right upper quadrant, and a post-operative scar on the abdomen. His vital signs were within normal ranges, i.e., body temperature 37.5℃, blood pressure 120/80 mmHg, heart rate 82/min, respiratory rate 20/min, and biochemical laboratory studies were normal, i.e., aspartate transaminase 23 IU/L (normal 10-35 IU/L), alanine transaminase 28 IU/L (normal 0-40 IU/L), total bilirubin 0.56 mg/dL (normal 0.1-1.2 IU/L), alkaline phosphatase 139 IU/L (normal 80-270 IU/L), and gamma glutamyl transferase 72 IU/L (normal 0-50 IU/L). Initial plain abdominal radiographs demonstrated two surgical clips in the right upper quadrant of the abdomen (Figure 1), and the following abdomen-pelvic computerized tomography (CT) scan revealed a small stone in the CBD and some sandy stones in the dependent portion of the CBD without significant biliary dilatation (Figure 2).
A Common Bile Duct Stone formed by Suture Material after Open Cholecystectomy
Bottom Line: However, in Korea suture materials have rarely been found to act as a nidus for common bile duct calculus formation.Recently, we experienced a case in which suture material, that had migrated from a previous cholecystectomy site into the CBD, probably served as a nidus for common bile duct stone formation.The stone was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) and removed successfully using a basket.
Affiliation: Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
The use of non-absorbable suture materials for cystic duct ligation after cholecystectomy can expose patients to the risk of recurrent stone formation in the common bile duct (CBD). However, in Korea suture materials have rarely been found to act as a nidus for common bile duct calculus formation. Recently, we experienced a case in which suture material, that had migrated from a previous cholecystectomy site into the CBD, probably served as a nidus for common bile duct stone formation. The stone was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) and removed successfully using a basket. The authors report a case of surgical suture migration and discuss its subsequent role as a stone forming nucleus within the CBD in a patient who underwent open cholecystectomy; and include a review of the literature.
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