Journal Information
Vol. 87. Issue 3.
Pages 384-385 (July - September 2022)
Visits
...
Vol. 87. Issue 3.
Pages 384-385 (July - September 2022)
Clinical image in Gastroenterology
Open Access
Spontaneous passage of an impacted gallstone at the ampulla of Vater: “Laying-an-egg” sign
Paso espontáneo de un cálculo biliar impactado en la ampolla de Vater: signo de «poniendo un huevo»
Visits
...
A. Hokama
Corresponding author
hokama-a@med.u-ryukyu.ac.jp

Corresponding author. Department of Endoscopy, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa 903-0215, Japan. Tel.: +81-988951144; Fax: +81-988951414.
Departamento de Endoscopia, Escuela de Medicina de Posgrado, Universidad de Ryukyus, Okinawa, Japan
Article information
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Full Text

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.

Figure 1.

Endoscopy showed that the ampulla of Vater was slightly enlarged and a gallstone was impacted, presenting the “laying-an-egg” sign.

(0.11MB).
Ethical considerations

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 disclosure

No financial support was received in relation to this article.

Conflict of interest

The author declares that there is no conflict of interest.

References
[1]
T. Itoi, N. Ikeuchi, A. Sofuni, et al.
Spontaneous passage of bile duct stone, mimicking laying an egg (with video).
Gastrointest Endosc, 69 (2009), pp. 1389
[2]
S. Sanguanlosit, V. Viriyaroj, H. Yodying, et al.
The influence of stone size on spontaneous passage of common bile duct stones in patients with acute cholangitis: a retrospective cohort study.
Ann Med Surg, 60 (2020), pp. 72-75
[3]
T. Murabayashi, T. Ogawa, K. Ito, et al.
Spontaneous passage of a large common bile duct stone during computed tomography.
Dig Liver Dis, 48 (2016), pp. 1514
[4]
A. Cerezo-Ruiz, A. Luque-Molina, R. Giménez-Domenech, et al.
Attendance to a “normal delivery” of choledocholithiasis.
Turk J Gastroenterol, 30 (2019), pp. 1072-1073

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.

Copyright © 2022. Asociación Mexicana de Gastroenterología
Idiomas
Revista de Gastroenterología de México

Subscribe to our newsletter

Article options
Tools
es en
Política de cookies Cookies policy
Utilizamos cookies propias y de terceros para mejorar nuestros servicios y mostrarle publicidad relacionada con sus preferencias mediante el análisis de sus hábitos de navegación. Si continua navegando, consideramos que acepta su uso. Puede cambiar la configuración u obtener más información aquí. To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here.