Abstract

CARRION, Lorena; SIVIRA, Pedro; FOLKMANAS, William  and  NADDAF, Rubén. Recurrent primary biliary lithiasis. Gen [online]. 2025, vol.79, n.1, pp.47-50.  Epub Mar 09, 2025. ISSN 0016-3503.  https://doi.org/10.61155/gen.v79i1.732.

Common bile duct lithiasis, or lithiasis of the main bile duct, is defined as the presence of stones in the common bile duct, either due to their migration from the gallbladder (secondary common bile duct lithiasis) or their formation in situ within the bile duct (primary common bile duct lithiasis). The aim of this study is to present a case of recurrent primary biliary obstructive jaundice in a patient who underwent cholecystectomy three years ago. The patient is a 62-year-old woman with a history of extra-institutional endoscopic retrograde cholangiopancreatography (ERCP) for choledocholithiasis and conventional cholecystectomy in 2021. She also underwent ERCP in 2023 at our institution. The patient reported the onset of her current condition on June 6, 2024, characterized by abdominal pain of insidious onset, located in the epigastrium and radiating to the right and left hypochondrium. The pain was colicky, of moderate intensity, and associated with concomitant nausea. Twenty-four hours later, the patient developed generalized jaundice and a fever of 38.5°C, which subsided after the administration of intravenous dipyrone. She then presented at our center, where an evaluation was conducted. An abdominal ultrasound revealed a dilated common bile duct in its middle and distal portions (10 mm). Laboratory tests showed leukocytosis (23,300 white blood cells), 93.1% neutrophils, AST: 142 U/L, ALT: 132 U/L, ALP: 422 U/L, total bilirubin: 10.20 mg/dL, and direct bilirubin: 9.42 mg/dL. ERCP was performed, resulting in favorable clinical and biochemical outcomes, and the patient was discharged. In this case, the history of cholecystectomy is particularly relevant. Generally, the presence of stones within the bile duct after cholecystectomy is classified as "retained" if detected within two years of the surgery or "recurrent" if identified after this period.

Keywords : common bile duct stones; primary common bile duct stones; secondary common bile duct stones; cholecystectomy.

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