Faculty:
Dr. Ashok Bhatia (Sr. Consultant - General & Laparoscopic Surgery)
Dr. Rajesh Talwar (Sr. Consultant - Anesthesia)

Hospital:
RG Hospitals, Rajouri Garden, New Delhi.

Presenting/Chief Complaints:
A 40 year old female with history of ERCP + Stenting done in Feb 2022 at another hospital. Post ERCP she developed Surgical Emphysema as a complication for which she was admitted at the same hospital for 4-5 days. After discharge she was found to be continuously suffering from fever, abdominal pain & inability to eat.
She then presented to RG Hospitals, Rajouri Garden for further treatment. On further investigation MRCP revealed  Acute calculus cholecystitis with choledocholithiasis-(Multiple stones in the CBD).

Diagnosis:
Acute calculus cholecystitis with choledocholithiasis-(Multiple stones in the CBD)

Treatment/Procedure/Surgery:
Laparoscopic Cholecystectomy + CBD exploration + Stone removal + Primary Closure of the CBD under General Anesthesia

Operative Findings:
Intraoperatively a distended gallbladder, thick walled, inflamed, with pericholecystic adhesions was seen. Multiple small to large calculi with thick mucus in lumen. Calot’s triangle, Cystic duct-thick walled and wide with stones CBD dilated. Multiple small to large calculi – 39 in number impacted in the common hepatic duct and common bile duct. Choledocotomy was done, multiple stones removed from CBD using a nephroscope. Complete clearance of CBD assured by choledocoscopy. Cholecystectomy completed and GB extracted in endobag.

Course of Hospitalization and Condition of Patient at the Time of Discharge:
The patient responded well to the treatment and was discharged in a stable condition.