# Lime and lithiasis: a case of choledocholithiasis complicated by limy bile

## TL;DR

A rare case of bile filled with calcium carbonate sludge complicated the treatment of bile duct stones in a middle-aged man.

## Contribution

This paper adds a new clinical case to the limited literature on managing choledocholithiasis complicated by limy bile syndrome.

## Key findings

- Endoscopic treatment alone was insufficient for managing the bile duct obstruction.
- The patient required additional surgical intervention due to persistent complications.
- Limy bile syndrome complicates standard approaches to biliary stone disease.

## Abstract

Limy bile syndrome (LBS) is a condition in which the biliary tract is filled with radiodense calcium carbonate rich sludge. This rare condition can complicate the management of commonly encountered biliary conditions such as choledocholithiasis. We present a case of a male in his fifties who presented to hospital with a 12-day history of abdominal pain, nausea and jaundice. Imaging and laboratory findings demonstrated a dependent radio-dense substance within the biliary system as well as an obstructing calculus at the duodenal ampulla. Management with endoscopic retrograde cholangiopancreatography alone was insufficient and further surgical management was required. With no clear published guidelines on LBS and associated cholelithiasis, management is variable. We present this case as an addition to the literature on the management of choledocholithiasis complicated by LBS.