Introduction: 33-year-old female presented with acute epigastric pain and elevated liver function tests 3 years after gastric bypass and cholecystectomy: AST 583, ALT 237, total bilirubin 1.3. Ultrasound demonstrated a mildly dilated 7 mm common bile duct. She underwent an MRCP that demonstrated common bile duct dilation with normal distal tapering and no evidence of choledocholithiasis. At that time, the suspicion was for a passed common bile duct stone, and she was discharged home on Actigall. She represented the following month with recurrent epigastric pain. Her AST and ALT were mildly elevated at 151 and 105. Repeat ultrasound demonstrated increased dilation of the common bile duct to 1.1 cm. She was taken to the operating room for diagnostic laparoscopy with common bile duct exploration and choledochoduodenostomy.
Materials and Methods: A choledochotomy was performed with care taken to avoid the vasculature that is usually located at the 3 and 9 o'clock positions. A Fogerty catheter was passed and a small amount of crystals were noted on withdrawal. A duodenotomy was made, and a side to side anastomosis was performed using interrupted sutures of 2-0 Polysorb with the EndoStitch. Result: Postoperatively the patient did well. There was a small amount of bile leakage that resolved by POD#4, and the JP drain was removed prior to hospital discharge. Her liver function tests normalized. She developed loose stools that resolved after a short course of cholestyramine. At her one month follow up, she had not had any further episodes of similar abdominal pain.