Multiple Cystic Duct Stones Causing Choledochal Obstruction

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Figure 1 A 74-year-old man with obstructive jaundice was referred to our hospital for endoscopic retrograde cholangiopancreatography. Initial cholangiography showed multiple stones in what appeared to be the common bile duct.

Figure 2 After endoscopic sphincterotomy had been carried out, and a basket catheter introduced, cholangiography demonstrated that the stones were in the cystic duct. The common bile duct was dilated (14 mm), but did not contain any stones. The cystic duct showed a low implantation and it was dilated with multiple stones. The distal cystic duct showed two large stones whose pressure produced common bile duct obstruction (Mirizzi syndrome). The stones were removed by laparotomy, after cholecystectomy had been carried out.