Following admission to the hospital for intestinal obstruction, a 48-year-old woman states that she previously had undergone cholecystectomy and choledochoduodenostomy. The most likely indication for the performance of the choledochoduodenostomy was:
Multiple stones were present in the CBD at the previous operation. During exploration of the CBD, most stones can be removed by using Desjardin's forceps or under direct vision using a choledochoscope and Dormia basket. However, if there are multiple stones impacted in the lower part of the CBD, a drainage procedure may be indicated. The CBD must be dilated before considering performing a choledochoduodenostomy at the time of gallbladder surgery (Figure below). If a stone is present in a dilated CBD after previous cholecystectomy, a choledochoduodenostomy is performed, because the rate of recurrent jaundice is high (>20%). Alternatively ERCP and sphincterotomy could be considered.Treatment for invasive gallbladder cancer is cholecystectomy and a wedge resection of the liver along with a regional lymphadenectomy. The wedge resection of the liver is illustrated. Segments 4 and 5 together with the lymph node regions should be removed.
Hepatic metastasis were present.
Multiple stones were present in the gallbladder at the previous operation.
Multiple stones were present in the CBD at the previous operation.
The common hepatic duct had a stricture.
Pancreas