A COMMON BILE DUCT (CBD) STONE FORMED AROUND A SUTURE MATERIAL AFTER OPEN CHOLECYSTECTOMY: A CASE REPORT

Aims Among the numerous and various known predisposing factors, has been shown that the use of non-absorbable suture materials in hepatobiliary surgery, can expose patients to the risk of iatrogenic stones formation in the CBD. We described a rare case of CBD stone formation around a migrated nidus of non-absorbable prolene suture, after open cholecystectomy.

Methods We observed a 51 years-old female admitted in Surgical Department, with a one-month medical history of intermittent episodes of right upper quadrant abdominal pain associated with jaundice. Open cholecystectomy and Kehr’s T-tube insertion in CBD had been performed seventeen years earlier. In our Unit of Digestive Endoscopy, ERCP was performed three days after admission, and was demonstrated a large filling defect suggestive of a stone floating into a dilated CBD. After endoscopic sphincterotomy, a large stone was removed using papillary large balloon dilation and subsequent guided EHL in the course of peroral cholangioscopy with SpyGlass Direct Visualization System. The fragments of crushed stone were removed successfully and recovered using a Dormia basket and a retrieval balloon catheter. At an initial macroscopic examination, the removed stone was dark brown-colored, with irregularly shaped and filament-like threads projecting from it, formed for induced and progressive crystallization of bile salts around a nucleus of a non-absorbable prolene suture.

Results The hypothesis of possible phenomena such as chronic compression of surrounding tissues, ischemical damage and gradual erosion, are the basis of suture material’s migration in the lumen of CBD.

Conclusions The iatrogenic cause of CBD stone formation is mainly due to migration of foreign bodies such as surgical metallic clips, retained tubes or non-absorbable suture materials. Prolene has been widely used in hepatobiliary surgery, and in the literature, stone formation related to this kind of suture material is relatively uncommon but possible. Appropriate management requires timely identification and ERCP.