{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:50:22Z","timestamp":1761897022892,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,3,9]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>A 35-year-old woman presented to the surgical clinic complaining of right hypochondrial pain for 4 days. Abdominal examination revealed tenderness on deep palpation in the right hypochonrdium, with no palpable organs or masses. The patient had repeated attacks of the same pain that mandated repeated admissions to the emergency hospital and treated conservatively. The white blood cell count was 13\u2009000 cells\/\u03bcL. Ultrasound examination of the abdomen showed thick-walled gall bladder, thick bile, with no visible stones and acalculous cholecystitis was the diagnosis. Decision done for laparoscopic cholecystectomy. After removal of the gall bladder and opening the bladder, a thick milky contents was found to fill the gall bladder with no stones. The diagnosis of limy bile syndrome then done. Histopathological examination of the gall bladder showed features of chronic cholecystitis with no malignancy. The patient discharged on the third postoperative day with no complications.<\/jats:p>","DOI":"10.1136\/bcr-2018-228061","type":"journal-article","created":{"date-parts":[[2019,4,5]],"date-time":"2019-04-05T12:07:51Z","timestamp":1554466071000},"page":"e228061","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Limy bile syndrome presenting as acute acalculous cholecystitis"],"prefix":"10.1136","volume":"12","author":[{"given":"Ayad Ahmad","family":"Mohammed","sequence":"first","affiliation":[{"name":"Department of Surgery, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq"},{"name":"Department of Surgery, Azadi Teaching Hospital, Duhok, Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sardar Hassan","family":"Arif","sequence":"additional","affiliation":[{"name":"Department of Surgery, College of Medicine, University of Duhok, Duhok, Kurdistan Region, Iraq"},{"name":"Department of Surgery, Azadi Teaching Hospital, Duhok, Iraq"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,4,3]]},"reference":[{"key":"2025082706592281000_12.4.e228061.1","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1007\/BF02773585","article-title":"Review of five cases of limy bile--particularly on radiological, chemical and crystallographic studies--","volume":"14","author":"Saito","year":"1979","journal-title":"Gastroenterol Jpn"},{"key":"2025082706592281000_12.4.e228061.2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1965.03090030067028"},{"key":"2025082706592281000_12.4.e228061.3","first-page":"67","article-title":"Limy bile: a case of obstructive jaundice and review of 26 cases","volume":"49","author":"Tsukamoto","year":"2003","journal-title":"Osaka City Med J"},{"key":"2025082706592281000_12.4.e228061.4","doi-asserted-by":"crossref","first-page":"453","DOI":"10.3109\/00016923309132525","article-title":"On limy bile","volume":"14","author":"Knutsson","year":"1933","journal-title":"Acta radiol"},{"key":"2025082706592281000_12.4.e228061.5","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1053\/jpsu.2001.22310","article-title":"Milk of calcium cholelithiasis in children","volume":"36","author":"Wu","year":"2001","journal-title":"J Pediatr Surg"},{"key":"2025082706592281000_12.4.e228061.6","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1080\/00015458.2001.12098579","article-title":"Limy bile and laparoscopic cholecystectomy","volume":"101","author":"Onghena","year":"2001","journal-title":"Acta Chir Belg"},{"key":"2025082706592281000_12.4.e228061.7","doi-asserted-by":"publisher","DOI":"10.1007\/BF01297198"},{"key":"2025082706592281000_12.4.e228061.8","doi-asserted-by":"crossref","first-page":"44","DOI":"10.2169\/internalmedicine.42.44","article-title":"Limy bile syndrome complicated with primary hyperparathyroidism","volume":"42","author":"Takatori","year":"2003","journal-title":"Intern Med"},{"key":"2025082706592281000_12.4.e228061.9","doi-asserted-by":"crossref","first-page":"804","DOI":"10.2214\/ajr.179.3.1790804","article-title":"Milk of calcium in the common bile duct: CT identification","volume":"179","author":"Mazzie","year":"2002","journal-title":"American Journal of Roentgenology"},{"key":"2025082706592281000_12.4.e228061.10","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/BF01887674","article-title":"Sonographic findings in milk of calcium bile","volume":"7","author":"Chun","year":"1982","journal-title":"Gastrointest Radiol"},{"issue":"6-7","key":"2025082706592281000_12.4.e228061.11","first-page":"550","article-title":"Limy bile. 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