A 39-year-old man presented with right upper quadrant pain. Physical examination showed a positive Murphy’s sign. Laboratory examinations reported elevated hepatobiliary enzymes. CT scans identified gallstones in the common bile duct (CBD), after which endoscopic retrograde cholangiopancreatography was performed. The ampulla of Vater was slightly enlarged and a gallstone was impacted (Fig. 1), presenting the “laying-an-egg” sign1. As we were watching, the stone, measuring 4 mm, passed spontaneously. Papillotomy was then performed, and the remaining gallstones were extracted. The patient improved favorably, and cholangitis has not recurred. Without appropriate treatment, gallstone impaction at the ampulla of Vater can result in a high mortality rate. Clinicians sometimes encounter naturally improved cholangitis cases, which may be due to the spontaneous passage of CBD stones. Although the incidence of spontaneous passage is suspected to be 20%2, its documentation has been exceedingly rare1,3,4. A stone smaller than 5 mm in diameter is a key predictor of spontaneous gallstone passage in cholangitis2. Depending on the size and number of the impacted gallstones, endoscopic papillotomy and biliary drainage can be indicated.
The author declares that no experiments were performed on humans or animals in this article. The author has treated all patient data with confidentiality, anonymity. Informed consent was obtained from the patient.
Financial disclosureNo financial support was received in relation to this article.
Conflict of interestThe author declares that there is no conflict of interest.
Please cite this article as: Hokama A. Paso espontáneo de un cálculo biliar impactado en la ampolla de Vater:signo de «poniendo un huevo». Revista de Gastroenterología de México. 2022;87:384–385.
