Bile Duct Stones
Stones lodged in the common bile duct causing obstruction, jaundice, and potential cholangitis.
Overview
Common bile duct (CBD) stones occur when gallstones migrate from the gallbladder into the bile duct, or less commonly form within the duct itself. They cause obstruction leading to jaundice, cholangitis (infected bile), and pancreatitis. Dr. Bhagat's MS thesis was specifically on CBD stones — their presentation, diagnosis, and management.
Causes
- Migration of gallstones into CBD (secondary stones — most common)
- Primary CBD stones (formed in duct due to stasis/infection)
- Post-cholecystectomy retained stones
- Biliary stricture causing stasis
- Parasitic infection (Clonorchis)
Risk Factors
- Gallstones (primary risk)
- Previous cholecystectomy (retained stones)
- Biliary strictures
- Older age
- Biliary parasites (in endemic areas)
- Periampullary diverticulum
Symptoms
Diagnosis
- Liver function tests (elevated bilirubin, ALP, GGT)
- Ultrasound abdomen (dilated CBD >8mm, stones visible in 50%)
- MRCP (non-invasive, 95% sensitivity)
- Endoscopic ultrasound (EUS)
- ERCP (both diagnostic and therapeutic)
- CT scan
Treatment Options
Surgical Treatment
ERCP with sphincterotomy is the first-line treatment for CBD stones. If ERCP fails or is unavailable, laparoscopic CBD exploration (transcystic or choledochotomy approach) during cholecystectomy is an excellent alternative. Dr. Bhagat is trained in both approaches. For recurrent stones or very dilated ducts, choledochoduodenostomy provides definitive drainage.
Recovery
ERCP: Day-care procedure, resume normal diet same day. Laparoscopic CBD exploration: 2-3 days hospital stay. Cholecystectomy should be performed during same admission or within 2 weeks to prevent recurrence. Complete resolution expected.
Prevention
- Early cholecystectomy for symptomatic gallstones (before stones migrate)
- Treat biliary sludge
- Post-cholecystectomy: intraoperative cholangiogram to detect missed stones
Frequently Asked Questions
What's the difference between gallstones and bile duct stones?
Can bile duct stones be removed without surgery?
Expert Consultation Available
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