Radiological Findings in a Case of Stentolith-Leaving no Stones Unturned

Choledocholithiasis is a cause of significant morbidity which might be secondary due to passed off gall bladder calculi or primary when there is de-novo stone formation. Endoscopic retrograde cholangiopancreaticography (ERCP) has revolutionized the management of choledocholithiasis since it is minimally invasive and is effective for clearance of the common bile duct (CBD) stones. CBD stenting is often done to prevent recurrence, however may be accompanied by its own set of complications such as perforation, hemorrrhage, cholangitis, stent migration, stent occlusion, stent fracture and the formation of stentoliths. We report a case of an 82 year old man who had a history of CBD stent placement 10 years back for choledocholithiasis, following which he was asymptomatic. The patient was lost to follow up and presented to the hospital at present with features of obstructive jaundice. Radiological investigations revealed the formation of a stentolith over the retained stent. The stent acts as a nidus for stone formation. The management includes endoscopic stent-stone complex retrieval, laparoscopic management or open CBD exploration.