Chronic Calculous Cholecystitis with Dilated Common Bile Duct without Evidence of Stone or Stricture: A Rare Case Report and Surgical Considerations

Abstract

Background: Chronic calculous cholecystitis is a long-standing inflammatory disease of the gallbladder associated with gallstones. Repeated episodes of irritation and obstruction caused by gallstones lead to chronic inflammation, fibrosis, and thickening of the gallbladder wall. It may be associated with common bile duct (CBD) stones and CBD dilatation; however, CBD dilatation without evidence of a stone or stricture is rare. It commonly presents with recurrent right upper abdominal pain, nausea, and intolerance to fatty foods. Aim: To present a case of chronic calculous cholecystitis associated with dilatation of the common bile duct in the absence of choledocholithiasis or biliary stricture and to highlight the diagnostic challenges and management approach in such patients. Case Presentation: A 59-year-old woman presented with intermittent right upper quadrant abdominal pain for the previous 3 months, associated with nausea. Physical examination revealed mild tenderness in the right hypochondrium without guarding or a palpable mass. There was no history of fever, jaundice, vomiting, clay-coloured stools, pruritus, or significant weight loss. The patient had no previous history of pancreatitis, jaundice, abdominal surgery, or significant comorbid illness. Abdominal ultrasonography showed multiple gallstones with features suggestive of chronic calculous cholecystitis and a dilated common bile duct measuring 10 mm without a filling defect. Magnetic resonance cholangiopancreatography (MRCP) demonstrated multiple gallstones and CBD dilatation of 14 mm without evidence of choledocholithiasis, a mass lesion, or biliary stricture. The patient underwent laparoscopic cholecystectomy without endoscopic retrograde cholangiopancreatography (ERCP) or CBD stenting. The postoperative period was uneventful, and the patient remained asymptomatic during follow-up. Conclusion: Chronic calculous cholecystitis may occasionally present with dilatation of the common bile duct even in the absence of stones or strictures. Thorough preoperative evaluation is essential to exclude obstructive pathology and malignancy. Laparoscopic cholecystectomy remains an effective treatment.