77YO Male with long hx of cholelithiasis presented with RUQ pain, WBC 19.6 , bili 5.1, alk phos 325 and fever. Pre op. Dx. Of calculous cholecystitis, choledocholithiasis and cholangitis was made. Cholangiogram showed multiple CBD stones.
Dictated by Donald E. Wenner, MD FACS
77YO Male with long hx of cholelithiasis presented with RUQ pain, WBC 19.6 , bili 5.1, alk phos 325 and fever. Pre op. Dx. Of calculous cholecystitis, choledocholithiasis and cholangitis was made. Cholangiogram showed multiple CBD stones.
A choledochotomy approach was chosen. Pus drained from the CBD as it was opened. The MIG was prepared with choledochoscope (large lumen) and a Nitenol stone basket (2.4 Fr. X 80 cm) and a 4 Fr. arterial irrigation catheter were inserted into the two small MIG lumens. Bile duct stones were easily captured with the stone basket. Visualization was excellent with irrigation flowing through both the choledochoscope and irrigation catheter.
The entire biliary system was inspected and all purulence and debris washed out. We elected to place a T-tube to drain the CBD in this case with this degree of inflammation. The severely inflamed GB was removed as well. The patient’s septic picture resolved quickly, and he has made an uneventful recovery.
 |
 |