Lithiasic obstructive jaundice with multiple choledocholithiasis resolved by endoscopic retrograde cholangiopancreatography
DOI:
https://doi.org/10.5281/zenodo.21920989Keywords:
obstructive jaundice, choledocholithiasis, endoscopic retrograde cholangiopancreatography, cholelithiasis, papillotomy, case reportAbstract
Objective: To describe a case of lithiasic obstructive jaundice with a history of prolonged biliary pain, resolved by endoscopic retrograde cholangiopancreatography (ERCP).
Methods: We report the case of a 63-year-old woman with hypertension and an approximately 2-year history of colicky pain in the right hypochondrium radiating to the epigastrium and back, partially controlled with over-the-counter analgesics, who 12 days before admission developed jaundice, choluria and heartburn.
Results: Abdominal ultrasound showed a dilated common bile duct of 10 mm and multiple gallbladder microlithiasis. Laboratory tests showed an elevated liver profile, predominantly direct hyperbilirubinemia and CA 19-9 above the reference range. After surgical evaluation, the patient was admitted with a diagnosis of acute surgical abdomen and grade 2 arterial hypertension, developed an intercurrent urinary tract infection on the second hospital day, and on the third day underwent ERCP with precut, papillotomy, balloon dilation and extraction of multiple stones with a Dormia basket, without complications and with good contrast drainage at the end of the procedure. She progressed favorably, with no contraindication to subsequent cholecystectomy.
Conclusion: This case illustrates the classic presentation of choledocholithiasis with prolonged biliary pain and self-medication before the onset of jaundice, and confirms the value of ERCP as first-line diagnostic and therapeutic method for extracting stones from the main bile duct.
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