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dr_nidhi · Credits: 12986 My Scrapbook My Reading List 5 Books

Q.1 YEAR AFTER CHOLECYSTECTOMY,A PT. PRESENTED WTH 2.5 CM SIZE STONE IN CBD.TT OF CHOICE IS

A.CHOLEDOCHOLITHOTOMY WTH T-TUBE DRAINAGE
B.SUPRADOUDENAL CHOLEDOCHOTOMY WTH EXPLORATION
C.TRANS DOUDENAL CHOLEDOCHOTOMY WTH SPHINCTUROPLASTY
D.ENDOSCOPIC SPHINCTEROTOMY WTH STONE EXTRATION

drok · Credits: 500 My Scrapbook

ans is (c). but if the size is >2.5cm open laprotomy is preffered 4 recurrence of stone CBD .
correct me if am wrong.

med_00 · Credits: 3596 My Scrapbook

why nt D as the ans

drnikhil1 · Credits: 3863 My Scrapbook

Management of recurrent stones in CBD after cholecystectomy;

First priority- resuscitation of the patient

Second priority- relief of obstruction
endoscopic pappilotomy with sphincterotomy is the preffered first approach… stone is retrived with dormia basket

Stone romoval is not possible then placement of stent

Now if this technique fails, percutaneous transhepatic cholangiogram to provide the drainage

Surgery in the form of choledochotomy is now rarely performed bcoz most of the patients can be managed by minimally invasive surgery

Surgical approaches

Choledochotomy-

Supraduodenal choledochotomy- stone present in CBD

T tube drainage is provided in this technique

Trans duodenal shinceterotomy- when stone is found impacted near the ampulla of vater..

Choledochodeodenostomy-alternative to transduodenal approach in multiple stones n elderly patient

So the ans is d

Referance love n bailey page no [snip]

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