Introduction
The management of common bile duct (CBD) stones is well established. An
algorithm showing the available strategies for the management of CBD
stones following a routine or selective per-operative cholangiogram or a
pre-operative endoscopic retrograde cholangiopancreatogram is
illustrated in figure 1[1]. Although the laparoscopic exploration
for CBD stones has gained grounds over endoscopic retrograde
cholangiography ( ERCP) and sphincterotomy and duct clearance, there is
no consensus as to the ideal approach [2, 3]. The management
strategy chosen will depend on personal experience, equipment
availability, time and the availability of other departmental expertise
[3]. For a distally impacted CBD stone in a low resource setting, an
open approach will entail either leaving the stone where it is and carry
out a choledochoduodenostomy, or removing the stone through a
transduodenal sphincteroplasty [4]. We present herein a
hepaticoduodenostomy performed for an impacted distal CBD stone. This
retained and impacted stone had complicated an open cholecystectomy for
acute cholecystitis by causing biliary leakage from the dehisced ligated
cystic duct stump due to back pressure of bile. We present the following
case in accordance with the CARE reporting checklist.