Limy bile syndrome or milk of calcium bile: An unexpected encounter

Limy bile or milk of calcium bile caused due to precipitation of calcium salts in bile is an extremely rare condition of gall bladder, wherein the lumen of gall bladder is filled with chalky white paste like material. Not many cases have been reported till date.In this exceptional case, we tried to correlate the radiological and surgical findings with the histopathology.We hereby present an interesting case of a 59-year-old male who presented with dyspepsia and painful abdomen and was finally diagnosed with limy bile syndrome.The etiology of this rare entity is not fully understood, but it certainly has strong association with impacted stone at the neck of gall bladder and hyperparathyroidism. Females are more commonly affected than males. Patients usually present with complaints of painful abdomen and are commonly diagnosed radiologically, as a radiopacity in gall bladder. Cholecystectomy is the preferred method of treatment for this unusual condition and histopathologically chronic cholecystitis is seen along with presence of slender needle shaped crystals of calcium salts.A thorough evaluation of the clinicoradiological and histopathological findings can sometimes bring to light many uncommon variants of common looking pathologies.