II. Definitions

  1. Choledocholithiasis
    1. Gallstone in the Common Bile Duct
  2. Gallstone Pancreatitis
    1. Occurs when Common Bile Duct Stone obstructs the sphincter of oddi
    2. See Acute Pancreatitis

III. Epidemiology

  1. Occurs in 6-12% (up to 20%) of patients with Symptomatic Gallstones
  2. Common Bile Duct Stones pass spontaneously in 73% of cases

IV. Signs

  1. Biliary Colic
  2. Acute Cholecystitis
  3. Ascending Cholangitis
  4. Gallstone Pancreatitis (with Gallstone lodged at the sphincter of oddi)
    1. See Acute Pancreatitis
    2. Presents with Epigastric Pain, back pain, Vomiting and elevated serum Lipase

V. Labs

  1. Liver Function Tests (hepatic panel)
    1. Increased transaminases
    2. Increased cholestasis labs
    3. Total Serum Bilirubin >4 mg/dl
  2. Pancreatic labs
    1. Increased serum Lipase if Gallstone Pancreatitis present

VI. Imaging

  1. Right Upper Quadrant Ultrasound
    1. Common bile duct dilitation >6 mm (some guidelines use 8 mm cut-off)
    2. Efficacy: LR+ 8.1, LR- 0.3
  2. Magnetic Resonance Cholangiopancreatography (MRCP)
    1. Indicated where the Ultrasound and lab findings are non-diagnostic for a suspected Common Duct Stone
    2. Test Sensitivity 84% and Test Specificity 92% is more accurate than RUQ Ultrasound
  3. Endoscopic Ultrasound
    1. Test Sensitivity 94% and Test Specificity 89% (more accurate than RUQ Ultrasound and MRCP)
    2. Invasive study, but ERCP with stone removal, stenting or biopsy may be performed during the same procedure
    3. Complications in 4 to 10% include Acute Pancreatitis, acute cholangitits, bowel perforation and Upper GI Bleed
  4. References
    1. De Castro (2016) Endosc Ultrasound 5(2): 118-28 [PubMed]
    2. Giljaca (2015) Cochrane Database Syst Rev 2015(2):CD011549 +PMID: 25719224 [PubMed]
    3. Gurusamy (2015) Cochrane Database Syst Rev 2015(2):CD011548 +PMID: 25719223 [PubMed]
    4. Gurusamy (2015) Cochrane Database Syst Rev 2015(2):CD010339 +PMID: 25719222 [PubMed]

VII. Complications

  1. Recurrent biliary symptoms despite Cholecystectomy
  2. Ascending Cholangitis
  3. Gallstone Pancreatitis
    1. See Acute Pancreatitis

VIII. Management

  1. Laparoscopic Cholecystectomy AND
  2. Common Bile Duct Stone removal
    1. Laparoscopic stone extraction (preferred) or
    2. Intraoperative cholangiography or
      1. Selective postoperative ERCP if stones present
    3. Preoperative ERCP and then Cholecystectomy

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Related Studies

Ontology: Choledocholithiasis (C0701818)

Definition (MSHCZE) Přítomnost žlučových kaménků v žlučovém vývodu (choledochu). Může způsobit jeho uzavření a poruchu odtoku žluči se žloutenkou (viz cholestáza). Do žlučovodu se může kámen dostat ze žlučníku nebo zde může přímo vzniknout. Uzávěr žlučových cest s cholestázou a žloutenkou je nutné co nejrychleji řešit chirurgicky a někdy též endoskopicky – viz ERCP. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) Presence or formation of GALLSTONES in the COMMON BILE DUCT.
Concepts Disease or Syndrome (T047)
MSH D042883
SnomedCT 197376000, 197397004, 49910001
English CHOLEDOCHOLITHIASIS, choledocholithiasis, choledocholithiasis (diagnosis), Choledocholithiasis [Disease/Finding], Bile duct calculus, Cholelithiasis, Common Bile Duct, cholelithiasis; common duct, Choledocholithiasis
Dutch choledocholithiase, cholelithiasis; ductus choledochus, Choledocholithiasis, Cholelithiasis, ductus choledochus
Spanish Coledocolitiasis, Colédocolitiasis, coledocolitiasis, Colelitiasis del Colédoco, Colelitiasis del Conducto Biliar Común
Swedish Koledokolitiasis
Japanese ソウタンカンケッセキショウ, 総胆管結石症, 結石-総胆管, 総胆管胆石, 総胆管胆石症, 総胆管結石, 胆石-総胆管, 胆石症-総胆管
Czech choledocholitiáza, cholelitiáza žlučovodu, Choledocholitiáza
Finnish Sapenjohtimen kivitauti
Russian OBSHCHEGO ZHELCHNOGO PROTOKA KHOLELITIAZ, KHOLEDOKHOLITIAZ, KHOLELITIAZ OBSHCHEGO ZHELCHNOGO PROTOKA, ОБЩЕГО ЖЕЛЧНОГО ПРОТОКА ХОЛЕЛИТИАЗ, ХОЛЕДОХОЛИТИАЗ, ХОЛЕЛИТИАЗ ОБЩЕГО ЖЕЛЧНОГО ПРОТОКА
Italian Colelitiasi, dotto biliare comune, Coledocolitiasi
Polish Kamica przewodu żółciowego wspólnego, Żółciowa kamica przewodowa
Hungarian choledocholithiasis
Norwegian Kolelitiasis i hovedgallegangen, Gallegangsstein, Stein i gallegangen, Sten i gallegangen, Konkrement i ductus choledochus, Gallegangssten, Koledokolitiasis, Koledokuskonkrement
Portuguese Colelitíase do Colédoco, Coledocolitíase, Colelitíase do Ducto Biliar Comum
French Lithiase cholédocienne, Lithiase du cholédoque, Cholédocholithiase
German Choledocholithiasis, Cholelithiasis, Ductus-choledochus

Ontology: Pancreatitis due to gallstones (C0920243)

Concepts Disease or Syndrome (T047)
Dutch pancreatitis als gevolg van galstenen
French Pancréatite liée aux calculs biliaires
German Pankreatitis durch Gallensteine
Italian Pancreatite dovuta a calcoli biliari
Portuguese Pancreatite por litíase biliar
Spanish Pancreatitis secundaria a litiasis vesical
Japanese 胆石による膵炎, タンセキニヨルスイエン
Czech Pankreatitida způsobená žlučovými kameny
Hungarian Epekő okozta pancreatitis
English Pancreatitis due to gallstones