An Obstructive Calculus in the Common Bile Duct

Clinical History

A 61 year old lady presented with an acute onset of epigastric pain and loss of appetite. The patient is known to have uncomplicated cholelithiasis which was diagnosed 2 decades ago. Presently, the bloods revealed raised alkaline phosphatase of 200.

Case Description

Abdominal ultrasound revealed a distended gallbladder with multiple calculi. There was also intra and extrahepatic biliary dilatation present. The common bile duct measured 15 mm in AP calibre with a calculus (obstructive calculus) seen towards the distal end of the lumen. However, the pancreatic duct was not dilated.