Discussion-
Cholangitis can be a life-threatening condition.4It is
commonly known as the infection of the bile duct. Choledocholithiasis is
one of the predominant causes of cholangitis.4 The
cause of choledocholithiasis is mostly secondary to cholelithiasis which
is stones in the common bile duct. Biliary stones noted in the common
bile duct are usually formed in the gall bladder and travel to the bile
ducts where they cause blockage and inflammation. Given this commonly
accepted pathophysiology, the suspicion for cholelithiasis is low in
someone with missing gallbladder. As shown, in our case, we found a case
of choledocholithiasis after a decade of cholecystectomy which is quite
unusual. We are reporting a case of this happening 10 years post
cholecystectomy. We found two cases published with choledocholithiasis 3
decades post cholecystectomy. The older case was reported by Peters X
et. al in 2017 published a case in which they have reported
choledocholithiasis after almost 3 decades of
Cholecystectomy7. In 2024, another reported by Bird et
al.5
The pathophysiology of cholelithiasis post cholecystectomy is believed
to be due to the surgical clips placed during the cholecystectomy acting
as a nidus formation for the stone formation. 6Recurring biliary symptoms after surgery have been linked to remnant
cystic duct lithiasis (RCDL) 6 , in addition to
surgical clip migration.
It is still a matter of conjecture regarding the length of cystic duct
leading to the formation of cystic duct stone post cholecystectomy.
Clinicians must be extra vigilant on any abdominal pain with fever in a
case of cholecystectomy as the case of cholangitis could be easily
missed. As noted in our case and with previous case reports,
cholelithiasis can occur from 10 to 30 years after cholecystectomy.