II. Definitions
- Choledocholithiasis
- Gallstone in the Common Bile Duct
- Gallstone Pancreatitis
- Occurs when Common Bile Duct Stone obstructs the sphincter of oddi
- See Acute Pancreatitis
III. Epidemiology
- Occurs in 6-12% (up to 20%) of patients with Symptomatic Gallstones
- Common Bile Duct Stones pass spontaneously in 73% of cases
IV. Signs
- Biliary Colic
- Acute Cholecystitis
- Ascending Cholangitis
- Gallstone Pancreatitis (with Gallstone lodged at the sphincter of oddi)
- See Acute Pancreatitis
- Presents with Epigastric Pain, back pain, Vomiting and elevated serum Lipase
V. Labs
-
Liver Function Tests (hepatic panel)
- Increased transaminases
- Increased cholestasis labs
- Total Serum Bilirubin >4 mg/dl
- Pancreatic labs
- Increased serum Lipase if Gallstone Pancreatitis present
VI. Imaging
- Right Upper Quadrant Ultrasound
- Common bile duct dilitation >6 mm (some guidelines use 8 mm cut-off)
- Efficacy: LR+ 8.1, LR- 0.3
-
Magnetic Resonance Cholangiopancreatography (MRCP)
- Indicated where the Ultrasound and lab findings are non-diagnostic for a suspected Common Duct Stone
- Test Sensitivity 84% and Test Specificity 92% is more accurate than RUQ Ultrasound
- Endoscopic Ultrasound
- Test Sensitivity 94% and Test Specificity 89% (more accurate than RUQ Ultrasound and MRCP)
- Invasive study, but ERCP with stone removal, stenting or biopsy may be performed during the same procedure
- Complications in 4 to 10% include Acute Pancreatitis, acute cholangitits, bowel perforation and Upper GI Bleed
- References
- De Castro (2016) Endosc Ultrasound 5(2): 118-28 [PubMed]
- Giljaca (2015) Cochrane Database Syst Rev 2015(2):CD011549 +PMID: 25719224 [PubMed]
- Gurusamy (2015) Cochrane Database Syst Rev 2015(2):CD011548 +PMID: 25719223 [PubMed]
- Gurusamy (2015) Cochrane Database Syst Rev 2015(2):CD010339 +PMID: 25719222 [PubMed]
VII. Complications
- Recurrent biliary symptoms despite Cholecystectomy
- Ascending Cholangitis
- Gallstone Pancreatitis
VIII. 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
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Related Studies
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 |