Background : Webs in the common bile duct are extremely rare. The exact cause of these webs remains a subject of controversy. Some are believed to be congenital, while others seem to develop in the presence of chronic inflammation, indicating a possible pathological connection.

Methods : In this report, we present a case of a 66-year-old male who had a common bile duct web along with cholelithiasis, and hepatolithiasis.

Results : The patient came to the hospital because of pain in the upper right abdomen. An abdominal computed tomography scan revealed acute calculous cholecystitis with the presence of stones in the right intrahepatic duct, along with the formation of a stricture or web in the common bile duct. An attempt was made to perform an endoscopic retrograde cholangiopancreatography (ERCP), but the cannulation of the ampulla was unsuccessful. As a result, the patient was referred to the Department of Surgery for further treatment. Subsequently, a cholecystectomy was carried out, and the right intrahepatic duct stones were removed using a choledochoscope. A common bile duct exploration was conducted to excise the web, but unfortunately, a frozen biopsy couldn't be obtained due to unavailability at that time. The difficulty in excluding the possibility of malignancy through preoperative imaging studies led to the decision of performing a bile duct resection and creating a Roux-en-Y choledochojejunostomy.

Conclusions : A common bile duct web is an extremely uncommon condition, and the treatment approach may differ based on the specific patterns of biliary stenosis. In some cases, endoscopic intervention using balloon dilatation through ERCP could be a more effective treatment option than surgery.