Choledocholithiasis

Aka: Choledocholithiasis, Common Bile Duct Stone, Common Duct Stone

II. Definition

  1. Gallstone in the Common Bile Duct

III. Epidemiology

  1. Occurs in 6-12% of patients with 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)

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 Lipase if gallstone Pancreatitis present

VI. Imaging

  1. Ultrasound
    1. Common bile duct dilitation >6 mm (some guidelines use 8 mm cut-off)
  2. Magnetic Resonance Cholangiopancreatography (MRCP)
    1. Indicated where the Ultrasound and lab findings are non-diagnostic for a still suspected Common Duct Stone

VII. Complications

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

IX. References

  1. Abraham (2014) Am Fam Physician 89(10): 795-802 [PubMed]
  2. Portincasa (2006) Lancet 368(9531):230-9 [PubMed]
  3. Urbach (2001) Surg Endosc 15:4-13 [PubMed]

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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
Derived from the NIH UMLS (Unified Medical Language System)

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