II. Definition
- Gallstone in the Common Bile Duct
III. Epidemiology
- Occurs in 6-12% of patients with 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)
V. Labs
-
Liver Function Tests (hepatic panel)
- Increased transaminases
- Increased cholestasis labs
- Total Serum Bilirubin >4 mg/dl
- Pancreatic labs
- Increased Lipase if gallstone Pancreatitis present
VI. Imaging
-
Ultrasound
- Common bile duct dilitation >6 mm (some guidelines use 8 mm cut-off)
-
Magnetic Resonance Cholangiopancreatography (MRCP)
- Indicated where the Ultrasound and lab findings are non-diagnostic for a still suspected Common Duct Stone
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