COURVOISIER'S LAW - CASE REPORT OF AN ATYPICAL EXCEPTION

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 palpable gall bladder (exception to Courvoisiers law). The association of fever and rapid onset of jaundice always makes physicians think of cholangitis, when associated with palpable gall bladder along with intermittent jaundice generally periampullary carcinoma is considered. But in our case after investigations it turned out otherwise. After resolution of cholangitis, stones were secondarily removed surgically because of the large size of the stones.