Clinical Case of Choledocholithiasis With Prolonged Obstructive Jaundice

Choledocholithiasis is a complication in a significant proportion of patients with gallstone disease, with an estimated incidence of 8–16% among patients with symptomatic cholelithiasis. Choledocholithiasis with prolonged obstructive jaundice presents a significant diagnostic and therapeutic challenge. Delay in diagnosis and treatment may lead to complications of the hepatobiliary system, coagulation disorders, as well as secondary renal impairment. The article presents a description of the clinical course of the disease with multistage endoscopic intervention and postoperative complications.The aim of our study: to examine a clinical case of a patient with choledocholithiasis and prolonged obstructive jaundice.Case report: Patient X, 58 years old, presented with complaints of jaundice of the skin and sclera, general weakness, itching, pain in the right hypochondrium and epigastrium.Results and discussion. At the time of admission, ultrasound examination revealed that the gallbladder was completely filled with calculi, the wall thickness was up to 7.5 mm, the common bile duct was dilated to 11.7 mm, and in the middle third a calculus measuring 10.5 mm was found. There were signs of mucosal edema of the duodenum.Based on anamnesis, physical examination, and ultrasound findings, the patient was diagnosed with choledocholithiasis with obstructive jaundice and underwent endoscopic retrograde cholangiopancreatography, papillotomy, balloon extraction, and lavage.During the procedure, 16 calculi up to 14 mm were found and removed, and lavage with furacilin was performed.Five days later, a second intervention was performed—a repeat balloon revision, during which dilatation of the common bile duct to 17 mm was revealed, two calculi up to 6 mm were removed, and a pig-tail stent (7 Fr) was placed.Seven days after the second intervention, the patient’s condition worsened. A scheduled third revision of the bile ducts was performed: balloon extraction of a 6 mm calculus and stenting of the common bile duct dilated to 18 mm (8 Fr, 80 mm).Seven days after the intervention, the patient was discharged in satisfactory condition with stable hemodynamics for outpatient treatment.Complications of prolonged obstructive jaundice: functional hepatic impairment; renal dysfunction.Elective cholecystectomy is recommended after normalization of blood biochemical parameters.