Abstract
A 63-year-old man admitted for epigastralgia and jaundice was found in laboratory data to have elevated serum bilirubin. Cholecystocholedocholithiasis was diagnosed preoperatively based on abdominal X-ray, computed tomography (CT) and endoscopic retrograde cholangiopancreato-graphy (ERCP). After endoscopic nasobiliary drainage to decrease serum bilirubin, cholecystectomy and choledocholithotomy were conducted through the cystic duct. The gallbladder, containing slimy and solid limy bile, had an impacted calcium bilirubinate stone 1cm in diameter at the neck. Material removed from the bile duct was rubbery limy bile containing 93% calcium carbonate but no gallstone. Cystic duct obstruction is causative in limy bile formation, but no case has, to our knowledge, been reported of limy bile produced by a calcium bilirubinate stone and obstructive jaundice induced by limy bile alone. The impacted calcium bilirubinate stone appeared to induce limy bile in the gallbladder and limy bile moving from the gallbladder to the bile duct relieved the cystic duct obstruction causing obstructive jaundice.
