Expert Management of a Complex Impacted Common Bile Duct Stone at Bombay Gastro & Cancer Institute, Bathinda
A 53-year-old male presented with progressive jaundice, yellow discoloration of the eyes, dark urine, and upper abdominal discomfort. Clinical evaluation and laboratory investigations confirmed obstructive jaundice.
Magnetic Resonance Cholangiopancreatography (MRCP) revealed a large 18 mm stone impacted in the intrapancreatic portion of the common bile duct (CBD), causing complete biliary obstruction.
The patient underwent two ERCP procedures at another centre; however, both attempts failed because the stone was firmly impacted and could not be extracted endoscopically.
Surgical Management
Following unsuccessful endoscopic treatment, the patient underwent definitive surgery performed by Dr. Raman Garg, Consultant Surgical Gastroenterologist, Advanced GI, Laparoscopic & HPB Surgeon at Bombay Gastro & Cancer Institute, Bathinda.
The procedure included:
- Open cholecystectomy.
- Common bile duct (CBD) exploration.
- Removal of the impacted distal CBD stone.
- Intraoperative choledochoscopy to directly inspect the entire biliary tree and confirm complete duct clearance before closure.
Direct visualization of the bile duct ensured that no residual stones remained, significantly reducing the risk of recurrent obstruction.
Postoperative Recovery
The patient's recovery was smooth and uneventful.
- Jaundice began improving soon after surgery.
- Oral feeding was resumed early.
- No postoperative complications occurred.
- Discharged in satisfactory condition on the 2nd postoperative day.
Why This Case Is Important
ERCP is the preferred first-line treatment for most common bile duct stones. However, large impacted distal CBD stones, particularly those lodged within the intrapancreatic portion of the bile duct, may not always be amenable to endoscopic removal.
In such complex cases, CBD exploration combined with intraoperative choledochoscopy remains the gold standard for achieving complete stone clearance under direct vision. This approach minimizes the risk of retained stones, recurrent jaundice, cholangitis, and the need for repeat procedures.
This case highlights Dr. Raman Garg's expertise in managing difficult biliary stone disease and complex hepatopancreatobiliary (HPB) conditions when endoscopic treatment is unsuccessful.
Advanced Gallbladder, Bile Duct and Pancreatic Surgery by Dr. Raman Garg
Dr. Raman Garg is a leading Surgical Gastroenterologist in Bathinda, with expertise in the treatment of gallbladder stones, common bile duct (CBD) stones, obstructive jaundice, bile duct strictures, pancreatic disorders, liver diseases, gastrointestinal cancers, intestinal diseases, colorectal disorders, hernias, and other complex gastrointestinal conditions.
He performs advanced gastrointestinal, hepatobiliary (HPB), pancreatic, and minimally invasive surgical procedures, offering comprehensive treatment for both elective and emergency surgical conditions. Patients from Bathinda, Punjab, Haryana, Rajasthan, and neighbouring regions seek his expertise for complex gastrointestinal and biliary surgery.
Patient: 53-year-old Male
Diagnosis: Obstructive Jaundice due to an 18 mm Impacted Distal Common Bile Duct Stone
Procedure Performed: Open Cholecystectomy, Common Bile Duct (CBD) Exploration, Removal of Impacted CBD Stone, and Intraoperative Choledochoscopy to Confirm Complete Bile Duct Clearance
Operating Surgeon: Dr. Raman Garg, Surgical Gastroenterologist, Advanced GI, Laparoscopic & HPB Surgeon, Bombay Gastro & Cancer Institute, Bathinda
Outcome: Successful surgery with complete stone clearance, rapid recovery, and discharge on the 2nd postoperative day.
About Dr. Raman Garg
Dr. Raman Garg is a Consultant Surgical Gastroenterologist, Advanced GI, Laparoscopic and HPB Surgeon at Bombay Gastro & Cancer Institute, Bathinda. He specializes in gastrointestinal cancer surgery, liver, pancreas and bile duct surgery, colorectal surgery, hernia surgery, upper GI surgery, emergency abdominal surgery, and advanced minimally invasive procedures.
Patient identity has been withheld to maintain confidentiality. This case is shared for educational purposes with appropriate consent and privacy safeguards.
