21.8.18

A 45 years old female had reportedly undergone an ERCP attempt to clear the CBD of stones but the stones could not be removed, and a biliary stent was placed. Another endoscopic attempt was made a month later, perhaps with an additional sphincterotomy (no records available, as usual) but ending up with biliary peritonitis (possibly due to a duodenal perforation) which was treated with US guided pigtail catheter drainage. The patient recovered and an MRCP on 2nd August revealed 4 big stones in the bile duct

At open operation, the whole upper abdomen was found to be frozen in postperitonitis adhesions, and the CBD was located with great difficulty, and confirmed with needle aspiration. At choledochotomy, the CBD was found to be clear, with no stones. This was confirmed with choledochoscopy. A T-tube drain was placed. The gallbladder was not found. Postoperatively the patient did very well and remains well.

Why were there no stones in the CBD?? Possible they had passed out through the sphincterotomy!

20.10.18

An obese 40 years old lady, having consulted Columbia Hospital, reported for laparoscopic cholecystectomy. She had elevated serum alkaline phosphatase levels assessed repeatedly over a period of nearly two months, raising a suspicion of CBD stones. However, an MRCP showed no stones and a regular laparoscopic cholecystectomy was done.