From Biliary Colic to Deep Jaundice: A Case Report of Complex Choledocholithiasis

Abstract

Obstructive jaundice is a common clinical condition that may result from obstruction of the biliary tract, with choledocholithiasis representing one of the most frequent causes. This case report aimed to describe the clinical presentation, diagnostic approach, and surgical management of severe obstructive jaundice caused by multiple common bile duct stones. A 44-year-old man presented with progressive right upper quadrant abdominal pain, jaundice, pruritus, pale stools, and dark urine. Physical examination revealed icteric sclera and abdominal tenderness. Laboratory findings showed marked hyperbilirubinemia with a predominantly direct fraction and elevated liver enzymes. Abdominal ultrasonography, computed tomography, and magnetic resonance cholangiopancreatography demonstrated multiple gallstones and large stones within the common bile duct with intrahepatic and extrahepatic biliary dilatation. The patient underwent exploratory laparotomy with cholecystectomy, common bile duct exploration, stone extraction, and T-tube placement. Postoperative follow-up showed significant clinical improvement with resolution of jaundice and symptoms. This case highlighted the importance of comprehensive imaging evaluation and demonstrated that open surgical exploration with T-tube drainage remained an effective therapeutic option in complex choledocholithiasis when endoscopic management was not feasible.