A unique case of black choledocholithiasis: a video-based case review in the Pancreato-Biliary Division–Endoscopy Unit of National Liver Institute (NLI)

Background Black gall stones are consistently described in relation to haem turnover and hemolytic disorders. Black gall stones are also a frequent presentation in cirrhotic patients, principally due to hemolysis-related hypersplenism. Case presentation Herein, we present a case of an average built 83-year-old lady who was suffering from biliary-type abdominal episodes of pain. Neither clinical nor laboratory evidence of overt biliary obstruction, cholangitis, or pancreatitis was detected. Sonographic examination revealed the presence of calcular gall bladder with many small stones, dilated common bile duct (CBD), and biliary radicles, along with homogenous average-sized liver, average-sized spleen with normal echogenicity and no focal lesions. Endoscopic retrograde cholangiography (ERC) was performed with wide papillotomy which was surprisingly followed by a drift of innumerable intensely black small stones. Conclusion In aged population, absence of the full-blown clinical syndrome in relation to complicated CBD stones should not exclude endoscopic intervention.