PTCD and choledochoscopy for recurrent choledocholithiasis after multiple abdominal surgeries: a case report

Background: Special attention should be given to intra-abdominal adhesions in patients with a history of open cholecystectomy for gallstones or abdominal surgery. Choosing the appropriate surgical approach to remove the stones is crucial.

Patient summary: A 68-year-old male was admitted due to sudden onset of upper abdominal pain lasting more than 6 h. In 2018, he underwent open Billroth II surgery for gastric cancer at an external hospital, and in 2020, he underwent open cholecystectomy for gallstones. In August 2023, he received gamma knife treatment for recurrent gastric cancer brain metastasis at another hospital with good results. In December of the same year, the patient presented to our hospital due to recurrent common bile duct stones and cholangitis. Given his history of two abdominal surgeries, percutaneous transhepatic cholangiodrainage (PTCD) combined with choledochoscopic stone extraction was chosen, which was successful in completely removing the stones. A PTCD tube was left in place postoperatively.

Conclusion: For patients with a history of two or more abdominal surgeries who experience recurrent common bile duct stones, PTCD has the advantages of a shorter operative time, less blood loss, earlier postoperative ventilation, earlier resumption of eating, minimal trauma and faster recovery.