Limy bile (Milk of calcium bile) associated with gall stones discovered incidentally during laparoscopic cholecystectomy

INTRODUCTION: Limy bile is very rare condition in which the gall bladder is filled with a whitish material formed mainly of calcium carbonate. It may be associated with gall stones and present with epigastric and right upper quadrant pain, fever, nausea, and jaundice. The diagnosis is easily made during radiology showing opacification of the gallbladder or the bile ducts on plain abdominal X-rays and CT-scan. Most patients are treated with cholecystectomy. CASE PRESENTATION: A 35-year-old lady was complaining from right hypochondrial pain for 8 months. The pain was mainly at the late night and relieved with analgesics. During examination the patient had no jaundice and during abdominal examination there was deep tenderness in the right hypochonrdium. Ultrasound of the gallbladder showed evidence of multiple gall stones with bile sludge. During laparoscopic cholecystectomy the gall bladder was found to be filled with white creamy substance and multiple gall stones. The patient discharged next day with no postoperative complications. CONCLUSION: Limy bile is a rare clinical entity of unknown etiology but obstruction of the cystic duct may be the most important step in its occurrence. The condition needs cholecystectomy as in most of the cases it is associated with gall stones. There are no reported long term sequelae and long term follows up is not recommended. (C) 2019 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.