Choledocholithiasis refers to the presence of gallstones in the common bile duct (CBD), which can lead to bile duct obstruction and serious complications if untreated.
Key Points About Choledocholithiasis
🧱 Causes
- Primary stones: Form directly in the bile duct (usually brown pigment stones, often related to infections)
- Secondary stones: Most common; stones formed in the gallbladder (usually cholesterol stones) migrate into the CBD
⚠️ Risk Factors
- History of gallstones or cholelithiasis
- Older age
- Previous biliary surgery or interventions
- Biliary strictures or stasis
- Biliary tract infections
🩺 Symptoms
- Right upper quadrant or epigastric pain
- Jaundice (yellowing of skin and eyes)
- Dark urine and pale stools
- Pruritus (itching)
- Fever and chills if cholangitis develops (infection of bile ducts)
- Nausea and vomiting
🔍 Diagnosis
- Laboratory tests: Elevated bilirubin, alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and transaminases
- Ultrasound: May show dilated bile ducts; stones might be visible but often missed
- MRCP (Magnetic Resonance Cholangiopancreatography): Non-invasive, good for detecting bile duct stones
- ERCP (Endoscopic Retrograde Cholangiopancreatography): Diagnostic and therapeutic—can remove stones
- Endoscopic ultrasound (EUS): Highly sensitive for detecting small stones
🩺 Complications
- Acute cholangitis: Infection of the bile ducts (Charcot’s triad: fever, jaundice, right upper quadrant pain)
- Pancreatitis: Due to obstruction near the pancreatic duct
- Biliary cirrhosis if chronic obstruction occurs
💊 Treatment
- ERCP with stone extraction: Primary treatment
- Sphincterotomy during ERCP may be performed
- Surgical exploration of bile duct if ERCP is not possible
- Antibiotics if infection is present
- Cholecystectomy after stone removal to prevent recurrence