Presentation
Fever, jaundice, and recurrent upper abdominal pain for three months.
Patient Data
The common bile duct is dilated and measures >12 mm, while the portal vein is 9 mm. Two echogenic foci (calculi) are visible in the common bile duct. Intrahepatic bile ducts also appear dilated and edematous, suggesting cholangitis.
Case Discussion
Choledocholithiasis is the presence of stones in the common bile duct. The patient had a classical Charcot's triad of right upper abdominal pain, fever, and jaundice suggestive of cholangitis in the setting of CBD stones detected on ultrasound. Uncontrolled background diabetes contributed to the flare-up of the infection. The liver functions were deranged. However, the pancreas was normal. The patient had a laparoscopic cholecystectomy done 15 years ago.
Ultrasound is a readily available, low-cost investigation of choice for the detection of CBD stones; however, the sensitivity of transabdominal ultrasound varies from 20 to 90 percent 1. A high index of suspicion with a focused scan may yield higher pick-up rates.
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