Surgical Management of Choledocholithiasis in a Patient After Bariatric Surgery at a Rural Hospital.

Choledocholithiasis is a serious complication of gallstone disease, and its management can be challenging in patients with altered gastrointestinal anatomy following bariatric surgery. We report the case of a 73-year-old woman with a history of unspecified bariatric surgery who presented with abdominal pain and evidence of a 14-mm common bile duct stone and ductal dilation. Initial endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessful due to altered anatomy and an inability to traverse the duodenojejunal limb. In a rural hospital without advanced endoscopic options, open common bile duct exploration (OCBDE) was performed, successfully removing the stone. The patient recovered without complications. This case highlights the limitations of ERCP in post-bariatric surgery patients and the continued importance of OCBDE as a definitive, potentially lifesaving intervention in resource-limited or rural environments.