title: Bile duct stone formation around a nylon suture after gastrectomy: a case report.
abstract: BACKGROUND
  Many cases of choledocholiths formed around sutures and clips used during cholecystectomy have been reported. We describe a case of gallstone formation around a nylon suture after non-biliary surgery. To the best of our knowledge, this is the first report of such a case.
  
  
  METHODS
  A 75-year-old Japanese man, who had undergone distal gastrectomy for gastric cancer and reconstruction with the Billroth II method 8 years earlier, presented with gastric discomfort. Abdominal ultrasonography was conducted and we diagnosed cholecysto-choledocholithiasis with dilatation of the intrahepatic bile duct. He underwent cholecystectomy and cholangioduodenostomy for choledocholith removal. Gallstones, which had formed around a nylon suture used during the previous gastrectomy, were found in the bile duct. Sutures of the same material had also been placed on the duodenum. Chemical analysis revealed that the stones were composed of calcium bilirubinate. The patient was discharged on postoperative day 19, and choledocholithiasis has not recurred thus far.
  
  
  CONCLUSIONS
  The findings from this case suggest that standard, non-resorbable sutures used in gastrectomy may be associated with the formation of bile duct stones; therefore, absorbable suture material may be required to avert gallstone formation even in the case of gastrectomy.
authors.affiliation: Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata 950-1197, Japan. maechiyo@med.showa-u.ac.jp
authors.forename: Chiyo
authors.initials: C
authors.lastname: Maeda
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Yokoyama
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Otani
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Katada
authors.forename: Natsuru
authors.initials: N
authors.lastname: Sudo
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Ikeno
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Matsuura
authors.forename: Akira
authors.initials: A
authors.lastname: Iwaya
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Yamazaki
authors.forename: Shirou
authors.initials: S
authors.lastname: Kuwabara
authors.forename: Norio
authors.initials: N
authors.lastname: Katayanagi
mesh_terms: D000368:Aged; D001652:Bile Ducts / Q000473:pathology*; D042882:Gallstones / Q000209:etiology*; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D009757:Nylons; D013274:Stomach Neoplasms / Q000601:surgery; D013537:Sutures / Q000009:adverse effects*
chemical_list: D009757:Nylons