Cystic Duct Remnant Leading to Stump Cholelithiasis.

A 42-year-old male presented with a two-month history of right upper quadrant abdominal pain, worsening over four days. Six months earlier, he had undergone a laparoscopic cholecystectomy. Examination revealed no jaundice or tenderness, and liver function tests were normal. The patient's basic inflammatory markers were within the normal range. Ultrasound revealed a residual gallbladder stump or dilated cystic duct with a calculus, and magnetic resonance cholangiopancreatography (MRCP) demonstrated a 3 × 1 cm stump with an 8 mm hypointense focus. Endoscopic retrograde cholangiopancreatography (ERCP) was unsuccessful due to distorted anatomy. Surgical exploration confirmed a cystic duct remnant containing sludge and concretions, which was excised completely. Postoperative recovery was uneventful, and histopathology revealed chronic inflammatory changes consistent with cystic duct stump pathology. This case illustrates that residual gallbladder stump cholelithiasis may occur after laparoscopic cholecystectomy. Recognition of this possibility, along with appropriate imaging, enables timely diagnosis. Surgical excision of the cystic duct remnant provides definitive treatment and effective symptom relief in patients with post-cholecystectomy syndrome caused by residual ductal concretions.