# Challenging Management of Acute Cholangitis in a Patient With Unextractable Common Bile Duct Stone Post Gastrojejunostomy Surgery

## TL;DR

An elderly patient with a complex surgical history and a difficult bile duct stone was successfully treated using advanced endoscopic techniques.

## Contribution

Demonstrates the effectiveness of innovative endoscopic methods in managing complex biliary disorders in elderly patients.

## Key findings

- A multidisciplinary approach was used to manage acute cholangitis in a patient with altered anatomy.
- Advanced endoscopic techniques like cholangioscopy and EHL enabled successful stone removal.
- The case highlights the importance of individualized care for complex biliary disorders.

## Abstract

This case report details the management of an 89-year-old female with a complex surgical history, including cholecystectomy, left hepatectomy, and repair of an iatrogenic duodenal perforation, who presented with acute cholangitis due to a large common bile duct stone. Faced with the challenges of altered anatomy and the patient's frailty, a multidisciplinary team employed a series of interventions, including percutaneous transhepatic biliary drainage and endoscopic retrograde cholangiopancreatography (ERCP). The case was further complicated by difficulties in navigating the altered biliary tract, necessitating the use of advanced endoscopic techniques such as cholangioscopy and electrohydraulic lithotripsy (EHL) for stone fragmentation and removal, leading to the successful resolution of the obstruction. This report underscores the importance of individualized care and highlights the efficacy of innovative endoscopic approaches in managing complex biliary disorders in elderly patients with significant surgical histories.