52 yrs old male not a known case of htn and t2dm.... Cholelithiasis ... Laparoscopic cholecystectomy done.... IOF.... Wall inflammed,,, gb distended containing multiple calculi...,,, calots triangle anatomy clear......plane between gb and liver not well defined... Drain kept... 50 ml serous discharge on day one... No drain output fir 3 days..... Drain removed... Now patient is having mild icterus.. Abdomen soft non distended and non tender... Normal stools and urine colour... LFT report attached..how to proceed now

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Do USG scan for collection, IHBR dilatation Rule out sepsis Wait for 3-4 days with serial LFt monitoring ,if increasing do MRCP and evaluate for bile leak

Sir I am confused,the case was of Choledocholithiasis means stone in CBD.Lapcholy done. Blood report shows high alkaline phosphatase suggests Obstructive Jaundice. In my opinion,ERCP with clearance of stone in CBD followed by Laparoscopic Cholecystectomy would be ideal. Yet Surgeon's opinion & plan always acceptable.

It was a case of cholelithiasis.... Choledocholithiasis was mistakenly typed
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As alkaline phosphatase is significantly raised and abdomen is soft , non tender , non distended , most likely a CBD stone . Unlikely to be any collection or CBD injury. Get an ultrasound scan abdomen. If a calculus in CBD in CBD is suspected get an ERCP done with CBD clearance

Thank you doctor
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LFT SUGGESTIVE VIRAL HEPATITIS AST ALT ARE RELATIVELY MORE THAN A LP THIS IS SUGGESTIVE THERE IS NO CBD OBSTRUCTION / OBSTRUCTIVE JAUMDICE . WATCH NORMAL DIET NO DRUG FOR JAUNDICE

Most likely CBD stone due to raised alkaline phosphatase.

Was ercp cbd clearance done. If not may proceed with Ercp direct

Why ERCP
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? CBD STONE Obstruction jaundice Adv ERCP with ENDOSCOPIC BILIARY SPHINCTOTOMY with stenting

I agree
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Do mrcp look for cbd stone or stricture Then plan Ercp

ERCP done showing 19 mm stone impacted at papilla.... Cholangiogram done.... Clips intact.... No spillage of dye

Sorry choledocholithiasis mistakenly typed

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