Stumped: A Tale of Gallbladder Stump Calculus Two Decades after Cholecystectomy

Abstract

Background: Gallbladder stump calculus is an uncommon delayed cause of recurrent biliary symptoms after cholecystectomy and can be difficult to recognise when previous surgery has altered the anatomy. Case Presentation: A 56-year-old female with diabetes mellitus and hypertension presented with intermittent postprandial upper abdominal pain approximately 20 years after open cholecystectomy. Abdominal ultrasonography identified a 12-mm calculus within the gallbladder stump, and magnetic resonance cholangiopancreatography demonstrated a 10-mm calculus in the remnant gallbladder stump. Operative management was undertaken through the previous right subcostal incision. Dense adhesions involving the pylorus and proximal duodenum obscured the gallbladder fossa, and the remnant stump and calculus could not initially be identified despite careful dissection and delineation of the common bile duct. Intraoperative ultrasonography localised the remnant and calculus, enabling further dissection. The stump was separated from the underlying common bile duct, ligated, clipped and excised. Outcome: The postoperative course was uneventful. Oral intake was commenced on postoperative day 1, the drain was removed on day 4, and the patient was discharged in stable condition on day 5. She remained asymptomatic at one- and three-month follow-up. Conclusion: Gallbladder stump calculus should be considered in patients with recurrent biliary symptoms long after cholecystectomy. Magnetic resonance cholangiopancreatography and intraoperative ultrasonography can assist anatomical definition and operative localisation in difficult reoperative fields.