Abstract
Choledocholithiasis is the presence of stones in the common bile duct (CBD). Choledocholithiasis in post-cholecystectomy is rare. Nonetheless, this is a report of a 40-year-old woman who was presented with severe epigastric pain with high-grade fever, tea-coloured urine, pale stool, and jaundice. She had a history of pangastritis and had cholecystectomy two years ago.This case report describes the significant diagnostic dilemma of the choledocholithiasis, particularly in a post-cholecystectomy patient who had pangastritis and was presented with severe epigastric pain. The diagnosis of choledocholithiasis was missed as the early symptoms of choledocholithiasis are similar to those of pangastritis. Therefore, treatment for choledocholithiasis was delayed. A high index of suspicion for diagnosis of choledocholithiasis must be emphasized among primary care practitioners even in a post-cholecystectomy patient. This will enable early treatment for the patient and prevent complications such as ascending cholangitis and sepsis. Bangladesh Journal of Medical Science Vol. 21 No. 02 April’22 Page : 458-462
Highlights
Ascending cholangitis (AC) is a bacterial infection of a bile duct system due to biliary obstruction
The duodenum is the typical source of ascending organism to the bile duct system while hematogenous spread from portal vein is a rare source of infection.1The classical clinical triad presentation of acute cholangitis, namely the Charcot’s triad is a combination of right hypochondriac pain, jaundice, and fever
Diagnosis of common bile duct (CBD) stones can be a missed during preoperative ultrasound as they can be obscured by colonic gas or fatty tissues in obese patients
Summary
Ascending cholangitis (AC) is a bacterial infection of a bile duct system due to biliary obstruction. The patient had a history of tea-coloured urine and pale stool for five days prior to admission Five months prior, she had a frequent attack of severe epigastric pain that was radiated to both scapula region almost every month especially after taking fatty food such as curry and oily food. Her renal function test results were normal She was diagnosed with a septic shock secondary to ascending cholangitis due to a distal CBD stone.
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