A Case of Limy Bile Migrating into the Common Bile Duct with Impacted Stone of Gallbladder

Takahiro (Nin) Toyokawa, Masafumi Ogawa, Tsutomu Takashima^*, Masanao Yamasaki^*, Hiroaki Tanaka^* and Shyouhei Sakasaki

Department of Surgery, Sakai Onshinkai Hospital
Department of Surgical Oncology, Osaka City University Graduate School of Medicine^*

A 50-year-old woman reporting epigastralgia was found in abdominal radiography in the supine position to have a calcified shadow of the gallbladder and common bile duct. In standing radiography, however, this calcified shadow produced two phases separated by a fluid-fluid level. Further examination showed stones in the gallbladder and CBD accompanied by limy bile, necessitating cholecystectomy. Pathological gallbladder findings indicated chronic cholecystitis. The stone in the CBD consisted of 79% cholesterol and 21% calcium carbonate, while the limy bile consisted of over 98% calcium carbonate.
Limy bile, which consists mainly of calcium carbonate, is known by its typical pattern in plain abdominal radiography. The occurrence of limy bile indicates some obstruction in the cystic duct or gallbladder neck. Limy bile is therefore usually found only in the gallbladder and rarely in the CBD. In our case, limy bile migrated into the CBD with an impacted stone. We accompany this report with a review of 21 cases of limy bile in the CBD and reported in the Japanese literature.

Key words
limy bile, common bile duct, CBD stone

Reprint requests
Takahiro Toyokawa Department of Surgery, Sakai Onshinkai Hospital 2140-1 Fukaishimizu-machi, Sakai, 599-8273 JAPAN

Accepted
December 18, 2002

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