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Retained common bile duct stone after cholecystectomy — USMLE Step 3 MCQ

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HardSurgery (post-operative, follow-up)Retained common bile duct stone after cholecystectomyUSMLE Step 3

A 61-year-old woman is 10 days after laparoscopic cholecystectomy for acute cholecystitis. She has persistent right upper quadrant pain, fever, and jaundice. Temperature is 38.6 C, bilirubin is 4.2 mg/dL, alkaline phosphatase is 390 U/L, and ultrasound shows a dilated common bile duct. Which of the following is the most likely diagnosis?

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Correct answer: C — Retained common bile duct stone

Fever, jaundice, right upper quadrant pain, cholestatic liver tests, and common bile duct dilation after cholecystectomy suggest retained choledocholithiasis with cholangitis risk, requiring biliary evaluation and decompression.

Reference: ACS/SHEA/SAGES surgical guidance