Question:easy
A patient underwent cholecystectomy. A stone in the common bile duct (CBD) is detected 2 years after the surgery. What type of stone is it?
A patient underwent cholecystectomy. A stone in the common bile duct (CBD) is detected 2 years after the surgery. What type of stone is it?
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Recall the 2-year cut-off that distinguishes primary from secondary CBD stones after cholecystectomy.
Updated On: Jun 23, 2026
- Primary
- Secondary
- Tertiary
- Retained stone
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The Correct Option is A
Solution and Explanation
Classification of post-cholecystectomy CBD stones:
Choledocholithiasis after cholecystectomy is classified by the time of detection:
| Type | Timing | Origin |
|---|---|---|
| Retained | Within weeks post-op | Missed at surgery |
| Secondary (Residual) | Within 2 years post-op | Migrated from gallbladder / missed at surgery |
| Primary | After 2 years post-op | Formed de novo in CBD |
Mechanism of primary stone formation: Primary CBD stones are typically brown pigment stones. They form due to:
1. Biliary stasis (stricture, stenosis of the sphincter of Oddi)
2. Bacterial infection ($E.$ $coli$ produces $\beta$-glucuronidase, which deconjugates bilirubin glucuronide into free bilirubin that precipitates with calcium)
3. Altered bile composition in the duct itself
In this question: Stone detected at 2 years post-cholecystectomy = primary CBD stone (de novo formation in the bile duct).
\[\boxed{\text{Answer: A -- Primary}}\]
Choledocholithiasis after cholecystectomy is classified by the time of detection:
| Type | Timing | Origin |
|---|---|---|
| Retained | Within weeks post-op | Missed at surgery |
| Secondary (Residual) | Within 2 years post-op | Migrated from gallbladder / missed at surgery |
| Primary | After 2 years post-op | Formed de novo in CBD |
Mechanism of primary stone formation: Primary CBD stones are typically brown pigment stones. They form due to:
1. Biliary stasis (stricture, stenosis of the sphincter of Oddi)
2. Bacterial infection ($E.$ $coli$ produces $\beta$-glucuronidase, which deconjugates bilirubin glucuronide into free bilirubin that precipitates with calcium)
3. Altered bile composition in the duct itself
In this question: Stone detected at 2 years post-cholecystectomy = primary CBD stone (de novo formation in the bile duct).
\[\boxed{\text{Answer: A -- Primary}}\]
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