Step by step of a cholecystectomy with open biliary exploration plus duodenotomy for resolution of a gallstone impacted in the ampulla of Vater after failed endoscopic retrograde pancreatography cholangio (ERCP)

Introduction: Gallstones are common, affecting 6.1% of the world's population. Primary biliary choledocholithiasis is associated with biliary stasis, being more common in older patients and those with recurrent infections. Secondary choledocholithiasis, more common in the West, occurs when gallstones move into the bile duct. Methods: presents the case of a female patient who was admitted to a second level hospital in Esmeraldas, Ecuador, with symptoms of cholestatic syndrome, including abdominal pain in the right upper quadrant and generalized jaundice. An exhaustive review of his clinical record was carried out to analyze in detail his evolution and medical management. Discussion: patients with gallstones may present serious complications such as pancreatitis and cholangitis. Advanced imaging techniques have optimized diagnosis and treatment, with typical symptoms such as pain in the right upper quadrant and alterations in liver tests. Management varies according to the level of risk, using ERCP and intraoperative cholangiography; In complex cases, open exploration may be necessary. Close postoperative follow-up is crucial to identify complications, such as bile leaks and persistent stones. Conclusions: Choledocholithiasis, which affects 10-15% of patients with gallstones, can cause pancreatitis and cholangitis, highlighting the importance of timely diagnosis and treatment. Advances in imaging techniques have made it easier to identify and remove stones. Postoperative follow-up is crucial to detect complications such as bile leaks