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A 30-year-old woman was admitted at a Mumbai hospital with the complaint of pain in her abdomen, which she had been going for the last 7-8 days. She also had jaundice. She was given some symptomatic treatment by the local doctors she had visited earlier, but her pain and fever worsened. As her condition deteriorated, she was admitted at Wockhardt Hospital, Mumbai Central, where doctors found multiple stones in her gallbladder and a duct (common bile duct) coming out of the gall bladder.
"Any jaundice should at least get an ultrasound exam done along with liver function test," said Dr Shankar Zanwar, Consultant Gastroenterologist at Wockhardt Hospital, pointing out that the woman's condition could have not worsened had she been evaluated earlier.
The patient Bhavika Parekh (name changed) said, "Initially the pain was mild as I was taking the jaundice medicines but later the pain aggravated in epigastric and umbilical region."
When she was admitted to Wockhardt Hospital, she was having nausea, vomiting, intermittent fever with chill, weakness, giddiness from past 2 days along with the abdomen pain.
The doctors found her bile duct to be packed with moderate sized stones (ranging from 8-9mm each). After taking her for endoscopic bile duct removal, they removed a total of 30 stones by endoscopy procedure called ERCP.
"To best of our knowledge based on the published literature this is the maximum number of stones removed from the bile duct using ERCP in the region," Dr Zanwar said.
If the procedure was delayed further, the woman would have landed into sepsis which spread of high-level infection in the blood stream resulting in low blood pressure and need for ICU admission or pancreatitis which again can be a serious situation, the doctor noted.
"Removal of moderate sized, multiple stones in the CBD is a complex ERCP procedure which needs proper pre-procedure planning and patients need to be counselled regards to post procedure complications," he added.
Dr Mehdi Kazerouni, Consultant General Surgeon & Laparoscopic Surgeon, Wockhardt Hospital, Mumbai Central said that the early diagnosis of multiple CBD stones with immediate removal of stones via ERCP allowed them to do laparoscopic cholecystectomy (removal of gall bladder) within 48 hours.
This quick management saved the patient from possible complication such as cholangitis, pancreatitis, and obstructive jaundice, and she made remarkable recovery, he added.
Dr Kazerouni advised that patients with repeated symptoms of upper abdominal pain with or without jaundice should be evaluated early so that similar diagnosis can be made, and they can avoid major complications.
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