The function of the portal vein is to drain the blood mainly from the gastrointestinal tract to the liver and its thrombosis is an extremely unexpected outcome of an uncomplicated laparoscopic cholecystectomy. It is believed to be a rarely reported case to date in non-cirrhotic patients. A female patient, aged 43 years, presented to the surgical outpatient department with unexplained severe abdominal pain soon after laparoscopic cholecystectomy. A relative workup was done and radiological evidence revealed the thrombosis in the distal part of the portal vein at its bifurcation which completely occluded the left branch of the vein. Although rare, portal vein thrombosis should be concluded in the differentials for unexplained causes of abdominal pain in the postoperative period of laparoscopic cholecystectomy.

Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred to as Bouveret's syndrome. We present a case of gallstone-induced duodenal obstruction in an elderly female patient, diagnosed on a 64-slice MDCT scanner. One-stage surgery, that is, stone removal and cholecystectomy, was performed resulting in relief of obstruction and complete cure. Clinical features, multidetector computed tomography (MDCT) findings, and surgical management are discussed.

Introduction: Laparoscopic cholecystectomy (LC) is the most frequent surgical operation in general surgery. The focus of recent research has been on improving the procedure's safety. Over 80% of healthy livers have Rouviere's sulcus (RVS), which is a natural notch in the right lobe that is present in proximity to the confluence of the bile duct. It is frequently considered an important component of safety during LC. RVS demarcates the area of the common bile duct (CBD) from the liver bed for the gall bladder. This research intends to evaluate the frequency, its relation to CBD, and the critical view of safety (CVS) during LC. Materials and Methods: An observational study was performed in a cohort of 50 patients listed for LC between September 2021 and September 2022. The presence of RVS was confirmed after liver retraction and dissection commenced. After the creation of CVS, its relationship with CBD was documented. Additionally, the position of the cystic lymph node was also documented during the dissection. Results: The findings of this study revealed that out of 50 patients, only 40 (80%) had RVS. However, cystic lymph nodes were present more frequently in 48 (96%) patients. CVS was achieved in all the patients, and it revealed the presence of RVS above the cystic duct-CBD junction in 37 (74%), at the level of the junction in 11 (22%), and in two (4%) where the junction could not be demarcated. Conclusion: RVS is a reliable marker to dissect laterally to CBD while doing LC, which does not require any dissection and can be appreciated early during the procedure. However, its presence along with the cystic lymph node gives a better anatomical understanding of the area of CBD, thereby assisting in conducting the procedure safely.

Background: Relationship between cholecystectomy followed by postoperative dilatation of the common bile duct is uncertain. Various studies have shown variable results regarding the dilatation of common bile duct after cholecystectomy.Methods: This study was a 1-year prospective study conducted at IGMC, Shimla with consent and ethical approval from the committee. Total 50 cases of symptomatic cholelithiasis belonging to either sex admitted in Surgical Wards of IGMC Shimla for elective surgery were selected for the present study. Cholecystectomy was done in all cases, after doing all the investigations.Results: The mean preoperative CBD diameter in the study group was 4.2mm, 48 hours postoperatively was 5.58mm and at 1-month interval following cholecystectomy was 6.02mm, so the mean postoperative diameter observed was (6.02+5.58=5.8mm).Conclusions: Significant dilatation does occur in CBD which is purely compensatory as there was no evidence of any pathological dilatation. This dilatation occur only in early post-operative period till the CBD adapts to contain bile equal to the Gall Bladder.

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