A case of Multiple Cholesterol Stones in Gallbladder and Choledochus Treated by Laparoscopically

We report a case of 12-year-old girl with multiple cholesterol stones wich was rare in childhood in gallbladder and choledochus, who underwent a laparoscopic cholecystectomy and choledocholithotomy. This patient admitted to the hospital because of abdominal pain. She was diagnosed as having choledocholithiasis by ultrasonography, CT and ERCP. The patient was transferred to our hospital in the condition of ENDB tube being inserted in the choledochus. We performed the laparoscopic cholecystectomy and choledocholithotomy to remove stones in the choledochus. The stone was a polygon of 5-7 mm in diameter with outer yellowish layer, center of which had a core of bile pigmentation. The choledochus was primarily closed without leaving T-tube. The post-operative cholangiography revealed the impacted stone in the right hepatic duct extending directly from the choledochus. The second laparoscopic choledocholithotomy was performed on 12 POD. Because the position of the stone could be correctly assessed by the loop of the ENDB tube, the choledochus was opened at portion of just above the stone. The stones could be removed by grasping forceps. Oral intake was started on 6 POD after second operation and the ENBD tube was removed on the same day. She has been well without any recurrence of stone. Therefore, it is suggested that laparoscopic operation is good choice of treatment in cholelithiasis in children