# Cystic Duct Remnant Leading to Stump Cholelithiasis

## TL;DR

A patient developed gallstone-like symptoms from a leftover cystic duct after gallbladder removal surgery, which was resolved through surgical excision.

## Contribution

Highlights cystic duct remnant cholelithiasis as a rare but diagnosable cause of post-cholecystectomy syndrome.

## Key findings

- Residual cystic duct with concretions was identified as the cause of persistent symptoms after cholecystectomy.
- Surgical excision of the cystic duct remnant provided effective treatment and symptom relief.
- Imaging techniques like MRCP were crucial for diagnosing the condition.

## Abstract

A 42-year-old male presented with a two-month history of right upper quadrant abdominal pain, worsening over four days. Six months earlier, he had undergone a laparoscopic cholecystectomy. Examination revealed no jaundice or tenderness, and liver function tests were normal. The patient’s basic inflammatory markers were within the normal range. Ultrasound revealed a residual gallbladder stump or dilated cystic duct with a calculus, and magnetic resonance cholangiopancreatography (MRCP) demonstrated a 3 × 1 cm stump with an 8 mm hypointense focus. Endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessful due to distorted anatomy. Surgical exploration confirmed a cystic duct remnant containing sludge and concretions, which was excised completely. Postoperative recovery was uneventful, and histopathology revealed chronic inflammatory changes consistent with cystic duct stump pathology.

This case illustrates that residual gallbladder stump cholelithiasis may occur after laparoscopic cholecystectomy. Recognition of this possibility, along with appropriate imaging, enables timely diagnosis. Surgical excision of the cystic duct remnant provides definitive treatment and effective symptom relief in patients with post-cholecystectomy syndrome caused by residual ductal concretions.