Abstract
A bile duct stone is defined as large if it is more than 15mm in size and giant when it is 5cm or more. Giant staghorn calculi are usually uncommon but can be found in oriental cholangio-hepatitis and usually pigment stones. Bile infection appears to be the initial event leading to stone formation. The primary bile duct stones form within the bile ducts and usually of brown pigment type while secondary bile duct stones arise from gall bladder and intra or extra hepatic ducts. There are very few published reports which describe a giant staghorn calculus in the common bile duct (CBD). The purpose of this case report is to report a new rare case of giant staghorn CBD calculus and discuss the diagnostic and surgical approach because staghorn calculi are very rare in the biliary tract.
Highlights
Stones which produce obstruction of the common bile duct (CBD) may have arisen in the CBD, in the gall bladder or in the extrahepatic or intrahepatic ducts.[1]
Some patients may remain asymptomatic while others progress to symptomatic condition with deranged liver function test such as elevated serum gamma glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP).[2,3]
The commonest stones which originate in the gall bladder are the infective and cholesterol stones and later they may migrate to the CBD are of secondary bile duct stones (75%) while primary bile duct stones (25%) usually take origin within the bile duct where they enlarge by containing higher proportion of bilirubin form brown pigment type stones
Summary
Stones which produce obstruction of the CBD may have arisen in the CBD, in the gall bladder or in the extrahepatic or intrahepatic ducts.[1]. Patient’s general condition was normal, average built, oriented to time place person and mild icteric. Ultrasonography of the abdomen and pelvis showed contracted gall bladder with stone, prominent CBD with solitary stone (4cm) in the lumen with dilated intrahepatic biliary ducts. Intraoperative findings revealed small contracted gall bladder with small solitary stone and grossly dilated CBD containing a solitary large stone that filled CBD and common hepatic duct (CHD) completely (9cm×3cm) with extension into the right and left hepatic ducts (Figure 1). T-tube cholangiogram was done on 10th POD which revealed post cholecystectomy status with dilated CBD, CHD and intrahepatic biliary ducts with abrupt distal termination of CBD without residual calculus (Figure 2 & 3).
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