Foreign bodies in common bile duct in post cholecystectomy status—case series of 8 cases—A single center experience in western India

Abstract

Foreign bodies in common bile duct (CBD) are rare. Obstructive jaundice in patients who have undergone cholecystectomy may be due to a variety of causes. Common causes of obstruction in these cases are residual stones, inflammatory or ischaemic strictures following CBD injury during cholecystectomy or malignant strictures. Foreign bodies in the bile duct in these post cholecystectomy patients are known but reported very rarely. Clinical features and biochemistry of these patients are no different than those due to other causes mentioned above. Imaging studies will show obstruction due to stones or sludge or narrowing but may not give conclusive diagnosis of a foreign body. Endoscopic ultrasound is helpful in these cases as it shows a hyperechoic foreign body within the stone if the substance is a metallic clip. In our current case series, we are presenting eight such cases with post cholecystectomy foreign bodies, in the form of materials used for ligating or clipping the cystic duct before transection during cholecystectomy, or a mistakenly left behind gauze piece, migrating into the bile duct and forming a nidus for stone formation and causing CBD obstruction. To conclude, if a patient presents with biliary obstruction with a history of cholecystectomy, the possibility of foreign body in the CBD must be considered as a possible differential diagnosis.