Acute Cholangitis and Biliary Pancreatitis Secondary to Late Primary Choledocholithiasis 40 Years After Open Cholecystectomy: A Case Report

Resumen

Primary common bile duct stones after cholecystectomy are uncommon and may present with diagnostic uncertainty when they occur decades after surgery. A 75-year-old woman with diabetes, hypertension, hypothyroidism, and open cholecystectomy 40 years earlier presented with severe epigastric pain radiating in a belt-like pattern, fever, nausea, and bilious vomiting. Laboratory findings showed leukocytosis, direct hyperbilirubinemia, cholestatic enzyme elevation, and elevated amylase and lipase. Computed tomography demonstrated common bile duct dilation with abrupt distal tapering. She was diagnosed with mild acute pancreatitis and moderate acute cholangitis. Endoscopic retrograde cholangiopancreatography demonstrated a dilated biliary tree with two 8-millimeter filling defects; sphincterotomy and balloon sweeps achieved extraction of two stones. She improved clinically and biochemically and was discharged without post-procedure complications. This case highlights that primary choledocholithiasis remains a relevant differential diagnosis even four decades after cholecystectomy.