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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Bioscientia Medicina : Journal of Biomedicine and Translational Research
Sujek Miko Eka Putra
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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The Anicteric Giant: A Rare Case of Giant Choledocholithiasis and Multiple Cholelithiasis Presenting with Paradoxically Normal Bilirubin Profiles Sujek Miko Eka Putra; Mochammad Riskie Aditya Putra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1518

Abstract

Background: Giant choledocholithiasis, defined as common bile duct (CBD) calculi exceeding 15 mm, typically presents with Charcot’s triad or marked biochemical cholestasis. The phenomenon of silent or anicteric giant stones remains a dangerous diagnostic blind spot. We present a rare case of a massive biliary stone burden presenting with paradoxically normal bilirubin and liver enzyme profiles, challenging standard screening algorithms. Case presentation: A 61-year-old female presented with a 12-month history of intermittent epigastric pain and nausea, initially misdiagnosed as gastritis. Despite the chronicity, she denied jaundice or fever. Biochemical analysis revealed a Total Bilirubin of 0.39 mg/dL (Reference: 0.1–1.2 mg/dL) and normal gamma-glutamyl transferase (GGT) levels, indicating an absence of biochemical obstruction. Magnetic resonance cholangiopancreatography (MRCP) identified multiple cholelithiasis and a solitary giant CBD stone. Intraoperative exploration confirmed a CBD dilated to 22 mm containing a calculus measuring 28 mm × 22 mm. Due to the massive ductal dilation and risk of recurrent stasis, the patient underwent a retrograde cholecystectomy followed by biliary reconstruction via Roux-en-Y choledochojejunostomy. Conclusion: Giant choledocholithiasis can exist in a silent phase due to ductal compliance and the ball-valve mechanism, rendering bilirubin an unreliable screening tool. This case underscores the necessity of cross-sectional imaging in chronic abdominal pain, even when biochemical markers are normal. Roux-en-Y reconstruction remains the definitive management for giant stones in significantly dilated ducts to prevent recurrence and sump syndrome.
The Anicteric Giant: A Rare Case of Giant Choledocholithiasis and Multiple Cholelithiasis Presenting with Paradoxically Normal Bilirubin Profiles Sujek Miko Eka Putra; Mochammad Riskie Aditya Putra
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 2 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i2.1518

Abstract

Background: Giant choledocholithiasis, defined as common bile duct (CBD) calculi exceeding 15 mm, typically presents with Charcot’s triad or marked biochemical cholestasis. The phenomenon of silent or anicteric giant stones remains a dangerous diagnostic blind spot. We present a rare case of a massive biliary stone burden presenting with paradoxically normal bilirubin and liver enzyme profiles, challenging standard screening algorithms. Case presentation: A 61-year-old female presented with a 12-month history of intermittent epigastric pain and nausea, initially misdiagnosed as gastritis. Despite the chronicity, she denied jaundice or fever. Biochemical analysis revealed a Total Bilirubin of 0.39 mg/dL (Reference: 0.1–1.2 mg/dL) and normal gamma-glutamyl transferase (GGT) levels, indicating an absence of biochemical obstruction. Magnetic resonance cholangiopancreatography (MRCP) identified multiple cholelithiasis and a solitary giant CBD stone. Intraoperative exploration confirmed a CBD dilated to 22 mm containing a calculus measuring 28 mm × 22 mm. Due to the massive ductal dilation and risk of recurrent stasis, the patient underwent a retrograde cholecystectomy followed by biliary reconstruction via Roux-en-Y choledochojejunostomy. Conclusion: Giant choledocholithiasis can exist in a silent phase due to ductal compliance and the ball-valve mechanism, rendering bilirubin an unreliable screening tool. This case underscores the necessity of cross-sectional imaging in chronic abdominal pain, even when biochemical markers are normal. Roux-en-Y reconstruction remains the definitive management for giant stones in significantly dilated ducts to prevent recurrence and sump syndrome.
Co-Authors Mochammad Riskie Aditya Putra