Common bile duct stones ( Choledocholithiasis)

Background 

Common bile duct stones are very common surgical ailment seen in practice as the incidence of the gallbladder stone disease is high across globe. They usually occur secondary to slippage of the gallbladder stones in to the common bile duct which is also considered as complication of gallbladder stone disease. In Asian population, these stones can occur primarily in the common bile duct itself secondary to the recurrent infection of the bile duct. 

Symptoms of bile duct stones disease 

  1. Acute pain in the right upper quadrant of the abdomen
  2. Jaundice ( yellowish discolouration of eyes, skin, palms and soles) 
  3. High grade fever with chills
  4. Symptoms associated with acute pancreatitis like epigastric pain radiating to back 
  5. Nausea and vomiting 
  6. Recurrent attacks of pain 

Diagnosis and investigations 

These should not be ignored and patients usually present in the emergency with acute abdominal pain. Clinician will examine you and advice certain investigations and admission in case of acute pain

  1. Routine Blood investigations including your liver profile 
  2. Ultrasonography of the abdomen 
  3. Magnetic resonance imaging ( MRI) of the the upper abdomen is advised to evaluate the size and location  of the stones as it provides detail images

Treatment 

Once the diagnosis is confirmed, the goal of the treatment remains removal of the stones from the common bile duct as well as removing the source of the stones which is gallbladder itself. Various treatment modalities have been described but the commonly performed in practice are mentioned below

  1. Endoscopic Retrograde Cholangiopancreatography ( ERCP) is most commonly done procedure to remove the stones as well drain the infection from the bile duct. Usually the stent is placed in the bile duct during the procedure to effectively drain the bile which is removed after 3-4 weeks after the procedure. This procedure is absolutely safe at centres with expertise. 
  2. Surgical management –  The surgical treatment is usually divided in two parts depending upon the status of the disease. If primarily done ERCP is completely successful then next step remains  laparoscopic removal of gallbladder ( laparoscopic cholecystectomy).  In cases, where there are large primary stones, unsuccessful attempts of ERCP, multiple small to large  stones in common bile duct these patients will require Laparoscopic exploration of common bile duct. This procedure involves opening of your common bile and removing all the stones along with gallbladder. This procedure can be performed by routine open conventional surgery. 

Recovery after surgery for the patients remains excellent and the patients are usually discharged in 3-4 days in non complicated cases of bile duct stones. In many cases, surgeons and gastroenterologist perform the procedure in single admission of the patient.

To consult with best team of general and minimal access surgeons available at  The Surgeons House (SHL) in different global locations, please click this link for more details. 

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