Reporte de Caso Clínico: Migración de cálculo dificultoso

Abstract

BACKGROUND: Common bile duct lithiasis is a pathology with a high rate of migration of small stones to the duodenum. However, asymptomatic migration of stones larger than 1cm (macrolithiasis) is atypical. We present a case of migration of a macrocalculus located in the middle of the common bile duct. CASE REPORTS: We present the case of a 27-years-old man, who consulted for postprandial epigastric pain, that started 4 months ago. Abdominal ultrasound showed biliary sludge and common bile duct macrocalculus, with Cholangio-MRI the diagnosis was confirmed. A laparoscopic cholecystectomy with intraoperative cholangiography was performed. EVOLUTION: During the laparoscopic cholecystectomy, no stones were evidenced in the intraoperative cholangiograpy. Due to the disagreement between the preoperative IOC images, transcystic instrumentation with a Dormia basket was performed, without stone extraction. The patient had a favorably evolution, without complications due to the stone migration. Postoperative MRC was performed, without evidence of endoluminal images in the bile duct. CONCLUSIONS: Biliary pathology is dynamic, with the possibility of gallstone migration, even for large gallstones and complicated cases. Although ultrasound and MRI have high sensitivy for diagnosis; IOC is essential to diagnose and treat lithiasic pathology, resolving it in a single operating time, avoiding multiple procedures.