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<p>Choledocholithiasis complicates 10–15% of gallstone disease, typically involving few stones. Extensive common bile duct (CBD) stone burdens (&gt; 50) are rare, with no prior reports exceeding 65 stones. This case documents an unprecedented 287 CBD stones, highlighting unique diagnostic and therapeutic challenges. A 46-year-old male presented with progressive jaundice, mild right upper quadrant pain, and nausea, without significant medical history. Laboratory findings confirmed obstructive jaundice (total bilirubin 8.2 mg/dL, ALP 420 IU/L). MRCP and contrast-enhanced CT (CECT) revealed &gt; 150 CBD stones (3–11 mm) with additional intrahepatic and gallbladder calculi, and a dilated CBD (16 mm); however, intraoperative exploration confirmed a total of 287 CBD stones, highlighting known limitations of MRCP in extreme stone burdens due to volume-averaging and overlapping artifacts. Due to the extensive stone burden, open choledochotomy and cholecystectomy were performed, achieving complete clearance of 287 CBD stones. Postoperative recovery was uneventful, with normalized liver function and no complications at 6 month follow-up. Surpassing prior reports (e.g., 65 stones by Ünver et al.), this case underscores the limitations of ERCP in high-volume choledocholithiasis and the necessity of surgical intervention. Long-term surveillance is recommended due to recurrence risks. This record-setting case of 287 CBD stones emphasizes tailored diagnostics, surgical expertise, and the need for further research into etiologies and management of extreme biliary lithiasis, adhering to CARE guidelines.</p>

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Massive Choledocholithiasis with 287 Common Bile Duct: A Case Report and Review of Literature

  • 期刊论文

  • 发表日期：

    2026年3月6日

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  • Hemant Jain,
  • Abhishek Pareek

摘要

Choledocholithiasis complicates 10–15% of gallstone disease, typically involving few stones. Extensive common bile duct (CBD) stone burdens (> 50) are rare, with no prior reports exceeding 65 stones. This case documents an unprecedented 287 CBD stones, highlighting unique diagnostic and therapeutic challenges. A 46-year-old male presented with progressive jaundice, mild right upper quadrant pain, and nausea, without significant medical history. Laboratory findings confirmed obstructive jaundice (total bilirubin 8.2 mg/dL, ALP 420 IU/L). MRCP and contrast-enhanced CT (CECT) revealed > 150 CBD stones (3–11 mm) with additional intrahepatic and gallbladder calculi, and a dilated CBD (16 mm); however, intraoperative exploration confirmed a total of 287 CBD stones, highlighting known limitations of MRCP in extreme stone burdens due to volume-averaging and overlapping artifacts. Due to the extensive stone burden, open choledochotomy and cholecystectomy were performed, achieving complete clearance of 287 CBD stones. Postoperative recovery was uneventful, with normalized liver function and no complications at 6 month follow-up. Surpassing prior reports (e.g., 65 stones by Ünver et al.), this case underscores the limitations of ERCP in high-volume choledocholithiasis and the necessity of surgical intervention. Long-term surveillance is recommended due to recurrence risks. This record-setting case of 287 CBD stones emphasizes tailored diagnostics, surgical expertise, and the need for further research into etiologies and management of extreme biliary lithiasis, adhering to CARE guidelines.