Choledocholithiasis
Stones in the common bile duct causing jaundice and cholangitis.
Overview
Choledocholithiasis refers to stones in the common bile duct. It's essentially the same condition as 'bile duct stones' — stones that have migrated from the gallbladder or formed within the duct. If complicated by infection, it becomes cholangitis — a surgical emergency.
Causes
- Migration from gallbladder (most common)
- Primary duct stone formation
- Biliary stasis
- Post-cholecystectomy retained stones
Risk Factors
- Gallstones
- Older age
- Previous cholecystectomy
- Biliary anatomical variants
Symptoms
Diagnosis
- LFTs (elevated bilirubin, ALP, GGT)
- Ultrasound (dilated CBD)
- MRCP
- ERCP (diagnostic + therapeutic)
- EUS
Treatment Options
Surgical Treatment
ERCP with sphincterotomy and stone extraction is first-line. For failed ERCP or concurrent cholecystectomy, laparoscopic CBD exploration is excellent. Very large or impacted stones may need choledochotomy. Recurrent stones with dilated duct benefit from choledochoduodenostomy.
Recovery
ERCP: Same-day discharge. Cholecystectomy within 2 weeks to prevent recurrence. Laparoscopic CBD exploration: 2-3 days. Full recovery in 1-2 weeks.
Prevention
- Timely cholecystectomy for gallstones
- Intraoperative cholangiogram during cholecystectomy
Frequently Asked Questions
Is choledocholithiasis an emergency?
How is this different from gallstones?
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