GI
Choledocholithiasis
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Choledocholithiasis
, Common Bile Duct Stone, Common Duct Stone
See Also
Gallstone
(
Cholelithiasis
)
Biliary Colic
Acute Cholecystitis
Acute Gallstone Cholangitis
(
Ascending Cholangitis
)
Acalculous Cholecystitis
Definition
Gallstone
in the Common Bile Duct
Epidemiology
Occurs in 6-12% of patients with
Gallstone
s
Common Bile Duct Stones pass spontaneously in 73% of cases
Signs
Biliary Colic
Acute Cholecystitis
Ascending Cholangitis
Gallstone
Pancreatitis
(with
Gallstone
lodged at the sphincter of oddi)
Labs
Liver Function Test
s (hepatic panel)
Increased transaminases
Increased cholestasis labs
Total
Serum Bilirubin
>4 mg/dl
Pancreatic labs
Increased
Lipase
if gallstone
Pancreatitis
present
Imaging
Ultrasound
Common bile duct dilitation >6 mm (some guidelines use 8 mm cut-off)
Magnetic Resonance Cholangiopancreatography
(
MRCP
)
Indicated where the
Ultrasound
and lab findings are non-diagnostic for a still suspected Common Duct Stone
Complications
Recurrent biliary symptoms despite
Cholecystectomy
Ascending Cholangitis
Gallstone
Pancreatitis
Management
Laparoscopic Cholecystectomy
and
Common Bile Duct Stone removal
Laparoscopic stone extraction (preferred) or
Intraoperative cholangiography or
Selective postoperative
ERCP
if stones present
Preoperative
ERCP
and then
Cholecystectomy
References
Abraham (2014) Am Fam Physician 89(10): 795-802 [PubMed]
Portincasa (2006) Lancet 368(9531):230-9 [PubMed]
Urbach (2001) Surg Endosc 15:4-13 [PubMed]
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