Choledocholithiasis

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Overview

Choledocholithiasis is the presence of gallstones in the common bile duct. This condition causes jaundice and liver cell damage, and is a medical emergency, requiring the endoscopic retrograde cholangiopancreatography (ERCP) procedure or surgical treatment.

A tendency for this disease can be inherited.

Cause

While stones can frequently pass through the common bile duct into the duodenum, some stones may be too large to passthrough the CBD and will cause an obstruction.

Complications

This obstruction leads to jaundice, elevation in alkaline phosphatase, increase in conjugated bilirubin in the blood and increase in cholesterol in the blood. It can also cause acute pancreatitis and ascending cholangitis.

Diagnosis

Doctors can use a blood test of alkaline phosphatase, bilirubin and cholesterol to diagnose choledocholithiasis.

However, ultrasound demonstrating an enlarged common bile duct is the test of choice.

Treatment

Treatment involves removing the stone using ERCP. Typically, the gallbladder is then removed to prevent a future occurrence of common bile duct obstruction.

MRCP image of two stones in the distal common bile duct

Fluoroscopic image of multiple common bile duct stones seen at the time of ERCP and duodenoscope assisted cholangiopancreatography (DACP). The stone was impacted in the distal common bile duct and was crushed with intracorporeal lithotripsy.

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