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.