Following admission to the hospital for intestinal obstruction, a 48-year-old woman states that she previously had undergone cholecystectomy and choledochoduodenostomy. The most likely indication for the performance of the choledochoduodenostomy was:

Multiple stones were present in the CBD at the previous operation. During exploration of the CBD, most stones can be removed by using Desjardin's forceps or under direct vision using a choledochoscope and Dormia basket. However, if there are multiple stones impacted in the lower part of the CBD, a drainage procedure may be indicated. The CBD must be dilated before considering performing a choledochoduodenostomy at the time of gallbladder surgery (Figure below). If a stone is present in a dilated CBD after previous cholecystectomy, a choledochoduodenostomy is performed, because the rate of recurrent jaundice is high (>20%). Alternatively ERCP and sphincterotomy could be considered.Treatment for invasive gallbladder cancer is cholecystectomy and a wedge resection of the liver along with a regional lymphadenectomy. The wedge resection of the liver is illustrated. Segments 4 and 5 together with the lymph node regions should be removed.