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Case Report
Cholecystocholedochal fistula and choledocolithiasis of great elements: A surgical challenge
1 MD, General surgeon, Division of General Surgery/Laparoscopy, Centro Médico de Especialidades, Hospital General de Ciudad Juárez, Ciudad Juárez, Chihuahua, Mexico
2 MD, General surgeon, Division of General Surgery/Laparoscopy, Centro Médico de Especialidades, Ciudad Juárez, Chihuahua, Mexico
3 MD, General physician, Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Ciudad Juárez, Chihuahu, Mexico
4 MD, General physician, Escuela de Medicina y Ciencias de la Salud, Universidad Autónoma de Guadalajara, Zapopan, Jalisco, México
Address correspondence to:
Danai Hernández Carreón
Vicente Guerrero 8907, Fraccionamiento Las Quintas, CP 32401, Ciudad Juárez, Chihuahua,
Mexico
Message to Corresponding Author
Article ID: 100061S05CJ2025
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Jaime CAL, Aviléz CTP, Cereceres SJR, Carreón DH, De La Garza ASP. Cholecystocholedochal fistula and choledocolithiasis of great elements: A surgical challenge. Edorium J Surg 2025;11(1):1–6.ABSTRACT
Introduction: Choledocholithiasis, the most frequent complication of cholelithiasis, is defined as the presence of stones in the common bile duct. Mirizzi syndrome, a rare complication of cholelithiasis, appears with the impaction of stones in Hartmann’s pouch. Large element choledocholithiasis is considered when stones measure ≥15 mm.
Case Report: A 36-year-old female patient arrived at the emergency department presenting acute abdominal pain in the epigastrium, irradiated to the right hypochondrium accompanied by vomiting, choluria, and acholia. Hepatobiliary ultrasound showed cholelithiasis plus dilation of the bile ducts. Preoperative tests showed hyperbilirubinemia of 7.46 mg/dL with an obstructive pattern and alteration of liver function tests. Endoscopic retrograde cholangiopancreatography was performed and failed to mobilize the stone. During surgery a scleroatrophic gallbladder was identified without being able to identify the cystic duct and artery, suspecting a cholecystocholedochal fistula. A choledochotomy of 30 mm was performed to begin laparoscopic bile duct exploration. The extraction of 3 stones was achieved, the largest measuring 29 mm in diameter. Afterward, partial cholecystectomy was performed and a T-tube was placed through the choledochotomy. Intraoperative cholangiography was performed through a T-tube with adequate passage into the extrahepatic bile ducts toward the duodenum. Currently the patient is in her late postoperative period with a satisfactory evolution.
Conclusion: Secondary choledocholithiasis is a common disease as a complication of chronic cholelithiasis that, thanks to multiple advances, has been easily resolved due to ERCP with sphincterotomy and balloon sweep. However, there are cases such as choledocholithiasis of large elements in which its resolution through ERCP is not feasible.
Keywords: Choledocholithiasis, Cholelithiasis, Jaundice, Mirizzi syndrome
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Acknowledgments
We thank the staff of Centro Medico de Especialidades for their support and constant drive to learn.
Author Contributions:Cesar Alberto López Jaime - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Carlos Tadeo Perzabal Aviléz - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Saul Jasam Ruiz Cereceres - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Danai Hernández Carreón - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Ana Sofía Perzabal De La Garza - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Cesar Alberto López Jaime et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
