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Frossard and Bonvin International Journal of Emergency Medicine 2011, 4:18 http://www.intjem.com/content/4/1/18 CASE REPORT Open Access Charcot’s triad Jean Louis Frossard1* and Florent Bonvin2 Abstract Biliary stones are usually found in the gallbladder, but about 10-20% may spontaneously migrate into the common bile duct where they either remain trapped or migrate subsequently via the papilla of Vater into the duodenal lumen. In some cases, biliary stones may form de novo in the common bile duct because of local precipitating factors. We here present a spectacular case of huge gallstones impacted in the common bile duct (empierrement of the common bile duct) that led to the development. | Frossard and Bonvin International Journal of Emergency Medicine 2011 4 18 http www.intjem.eom content 4 1 18 o International Journal of Emergency Medicine a SpringerOpen Journal CASE REPORT Open Access Charcot s triad Jean Louis Frossard1 and Florent Bonvin2 Abstract Biliary stones are usually found in the gallbladder but about 10-20 may spontaneously migrate into the common bile duct where they either remain trapped or migrate subsequently via the papilla of Vater into the duodenal lumen. In some cases biliary stones may form de novo in the common bile duct because of local precipitating factors. We here present a spectacular case of huge gallstones impacted in the common bile duct empierrement of the common bile duct that led to the development of acute cholangitis with septic shock. Urgent nocturnal percutaneous cholangiography permitted biliary drainage and resolution of the cholangitis while the stones were secondarily removed surgically because of the large size of the stones. Acute suppurative cholangitis may be fatal unless adequate biliary drainage is obtained in a timely manner. The association of fever and rapid onset of jaundice in elderly patients should always make physicians think of cholangitis. Introduction Gallstone disease is one of the most prevalent of all digestive diseases in the United States and Europe. Gallstones do not induce symptoms in the majority of cases but only 2 to 4 of patients become symptomatic each year 1 . Case presentation A 82-year-old man with a previous history of open cholecystectomy performed 12 years ago presented with a three-day history of fever chills and progressive jaundice. Physical examination showed a temperature of 39.0 C that partially decreased after paracetamol administration. His blood pressure was 85 40 mm Hg and his pulse rate was 112 min. A complete blood count showed a leukocyte count of 34 100 cells mm3 and the CRP level was 311 mg dl. His liver function tests revealed a total bilirubin of 210 umol l
