Hepatolithiasis post cholecystectomy

Case contributed by Bertrand Ng
Diagnosis certain

Presentation

Right upper quadrant pain with a previous open cholecystectomy done 50 years ago.

Patient Data

Age: 70 years
Gender: Female

Extensive intrahepatic and extrahepatic bile duct dilatation with multiple hyperdense material within the intra and extrahepatic biliary tree.

Case Discussion

A 70-year-old lady presented with recurrent episodes of right upper quadrant pain. Her pain flares up every few months after taking oily food. She had a previous open cholecystectomy done 50 years ago. Her liver function test shows mild derangement in alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) at 120 U/L and 220 U/L, respectively, with a normal bilirubin level. A CT was performed with the images as above. She was subsequently admitted to the hepatobiliary team and had her hepatolithiasis surgically removed.

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