Recurrent residual choledocholithiasis after cholecystectomy – endoscopic exploration of bile ducts performed 6 times

IntroductionRecurrent residual choledocholithiasis refers to the presence of concretions in the bile ducts found in patients who have undergone cholecystectomy. The incidence of recurrent cholithiasis is estimated to be 2–10%, whereas the incidence of recurrent cholithiasis after endoscopic retrograde cholangiopancreatography (ERCP) amounts to 4–24%.AimThe aim of this paper was to analyze the case of a patient with recurrent choledocholithiasis after laparoscopic cholecystectomy, who underwent endoscopic exploration of the bile ducts performed 6 times, including endoscopic sphincterotomy (ES) and biliary prostheses.Case studyA 49-year old patient was admitted to the Teaching Hospital showing symptoms of extrahepatic cholestasis. On admittance, she reported nausea lasting for a few days, meteorism and strong pain typical of biliary colic, located in her right epigastric region and irradiating to her spine. Additionally, she complained of a bitter taste in her mouth and bitter belching. The patient had been operated on 9 years before for acute cholecystitis.Results and discussionThis presented case poses a question for a clinician concerning the risk factors for recurrent choledocholithiasis. In the majority of cases, i.e., as many as 80%, recurrent cholithiasis is detected within 3 years following ERCP with sphincterotomy. The risk of choledocholithiasis recurrence after endoscopic evacuation of the stones is within the range of 4–24%. The identification of factors causing this disease will contribute to its prevention, early diagnosis and treatment of any further recurrences and complications from choledocholithiasis. Data from published literature prove that damage to the sphincter causes chronic cholangitis, which then contributes to the formation of concretions. Other risk factors include dilated bile ducts and performed cholecystectomy. All these factors occurred and were observed in the analyzed patient.ConclusionsThe basic treatment for this recurrent disease is ES performed during an ERCP procedure. This case emphasizes those problems associated with the prevention and treatment of recurrent choledocholithiasis.