Choledocholithiasis

• Presentation
  • Many are asymptomatic
  • Obstructed jaundice (conjugated Bilirubin)
  • Raised ALP/GGT
  • Pale stool, dark urine
  • Can cause gallstone pancreatitis
• See
  • Bile duct exploration
  • Gallstone disease
  • Cholecystectomy
• What to do with incidentally found stones
  • At IOC
    • I would perform a Transcystic exploration
    • Post-op ERCP
  • If incidental on MRI or CT
    • Follow up imaging in 6 weeks
    • ERCP if persistent or further follow up
    • Evidence is week
  • Evidence
    • A Prospective Study of Common Bile Duct Calculi in Patients Undergoing Laparoscopic Cholecystectomy, page 1
      • 34 patients diagnosed with CBD stones discovered during laparoscopic cholecystectomy by routine IOC which was done for all patients with or without evidence of choledocholithiasis.
      • When found, a trans-cystic catheter was left in place for 6 weeks. It was found that, after 6 weeks of follow-up, one third of these patients had asymptomatic spontaneous duct clearance, while the remaining had persistent filling defects on cholangiogram and underwent ERCP.
      • The author concluded that It’s reasonable to manage the asymptomatic patients conservatively in the short term.
    • Best evidence topic- Should patients with asymptomatic choledocholithiasis be treated differently from those with symptomatic or complicated disease? , page 1