Abstract
Biliary stones are usually found in the gallbladder, but about 10-20% may spontaneously migrate into the common bile duct where they either remain trapped or migrate subsequently via the papilla of Vater into the duodenal lumen. In some cases, biliary stones may form de novo in the common bile duct because of local precipitating factors. We here present a spectacular case of huge gallstones impacted in the common bile duct (empierrement of the common bile duct) that led to the development of acute cholangitis with septic shock. Urgent nocturnal percutaneous cholangiography permitted biliary drainage and resolution of the cholangitis while the stones were secondarily removed surgically because of the large size of the stones.Acute suppurative cholangitis may be fatal unless adequate biliary drainage is obtained in a timely manner. The association of fever and rapid onset of jaundice in elderly patients should always make physicians think of cholangitis.
Highlights
Gallstone disease is one of the most prevalent of all digestive diseases in the United States and Europe
Case presentation A 82-year-old man with a previous history of open cholecystectomy performed 12 years ago presented with a three-day history of fever, chills and progressive jaundice
Because endoscopic drainage was not available at night, a CT scan was followed by percutaneous cholangiography that permitted a temporary drainage; aspiration of pus was sent to the laboratory and confirmed a typical massive “empierrement” of the common bile duct
Summary
Physical examination showed a temperature of 39.0°C that partially decreased after paracetamol administration His blood pressure was 85/40 mm Hg, and his pulse rate was 112/min. A complete blood count showed a leukocyte count of 34,100 cells/mm, and the CRP level was 311 mg/dl His liver function tests revealed a total bilirubin of 210 umol/l, an ALT of 175 U/l and an alkaline phosphatase of 394 U/l. Antibiotics (cefuroxim and metronidazol) were intravenously administered while waiting for diagnosis confirmation by CT scan the day after admission. Because endoscopic drainage was not available at night, a CT scan was followed by percutaneous cholangiography that permitted a temporary drainage; aspiration of pus was sent to the laboratory and confirmed a typical massive “empierrement” of the common bile duct. The planned surgery was not possible, and a biliary-digestive anastomosis was performed instead without any further complications
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