Pain and Fever Arising from the Common Bile Duct and not Associated with Jaundice

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When biliary colic, chills, or fever persist in a patient who has had a cholecystectomy for gall stones, the presence of a calculus in the common bile duct is often suspected. Yet, in the absence of stones in the gall bladder, it is only rarely that stones in the common duct produce these symptoms without causing sufficient obstruction to result in jaundice.

It is the purpose of this article to call attention to the fact that stones in the common duct may produce pain or fever without jaundice and to report 2 illustrative cases. A case of postoperative biliary dyskinesia relieved by vagotomy is also reported.

Case Reports

Case 1. Chills and fever without jaundice caused by a stone in the common duct. A 62-year-old white woman was admitted to the hospital complaining of chills and fever of 105° which had occurred approximately once a week for eighteen months. The attacks were accompanied by vomiting and vague upper abdominal distress, at times radiating to the back.

The only pertinent disclosure in her previous history was a cholecystectomy done sixteen years before for cholelithiasis. This patient had undergone extensive examination at another hospital, and a tentative diagnosis of undulant fever had been suggested. Undulant fever skin test and agglutination at Cleveland Clinic Hospital were negative, as were smears for malaria. Blood cultures, gastrointestinal x-rays, intravenous urogram, cystoscopy, and retrograde pyelogram were all negative. Icteric index was 7. There was no history of jaundice, and no jaundice followed the chills and fever. . .



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