Diagnosis
Choledocholithiasis
Presence of gallstones in the common bile duct.
Also known as: Common bile duct calculi, Common bile duct stone
Etiology
Cause [fzm]
Gallstone from the gallbladder passes into the common bile duct
Formation of stones in the common bile duct
Pathophysiology [fzm]
Gallstone in the common bile duct --> obstruction:
Proximal: bile obstruction (cholestasis)
Distally obstruction in the ampulla of Vater: bile and pancreatic obstruction
Abdominal pain and jaundice
Complications [fzm]
Ascending cholangitis
Sepsis
Gallstone pancreatitis
Post-ERCP Pancreatitis
Hepatitis
Mirizzi syndrome
Risk [p5m]
Female, Fat, Fertile, Forty, flatulent, Familial, Cystic Fibrosis, sickle cell anemia, pregnancy, oral contraceptives, Western diet, Crohns disease, Ulcerative colitis, hyperlipidemia, ileal resection (due to loss of enterohepatic circulation), and total parenteral nutrition
Epidemiology
Incidence per 100.000 [hqa][6cn][tp6][pmi][wpy][ohq]
Symptoms & findings
Symptoms
Anorexia, Charcot's triad, Fever, Icterus, Nausea, Vomiting
Clinical findings
Bile duct dilation, Cholestasis, Decreased Albumin, Elevated ALP, Elevated Bilirubin, Elevated CRP, Elevated PT-INR, Jaundice, Leukocytosis
Anamneses
None listed.
Localized findings
Approach
Blood test
Ultrasound abdomen
Endoscopic ultrasound
MRCP
ERCP
Treatment
In acute unstable patient: [p5m]
Blood culture
PTC for drainage + culture
Antibiotics
Definitive treatment:
ERCP with stone extraction
Endoscopic sphincterotomy
Endoscopic papillary balloon dilation (EPBD)
Cholecystectomy
Differential diagnoses
Acute mesenteric ischemia, Acute pancreatitis, Aortic dissection, Appendicitis, Benign bile duct tumor, Bile duct stricture, Cholangiocarcinoma, Cholangitis, Cholecystitis, Choledochal cysts, Choledocholithiasis, Cholelithiasis, Gallbladder cancer, Gastritis, Pancreatic cancer, Perforated ulcer, Primary sclerosing cholangitis, Pyelonephritis, Ruptured aortic aneurysm, Ulcer disease
References
[1] McNicoll CF, Pastorino A, Farooq U, et al. Choledocholithiasis. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441961/
[2] http://emedicine.medscape.com/article/175667 (2014-01-02); [Medscape]
[3] Li et al. Epidemiology and outcomes of choledocholithiasis and cholangitis in the United States: trends and urban-rural variations. BMC Gastroenterol. 2023 Jul 27;23(1):254.
[4] Molvar C, Glaenzer B. Choledocholithiasis: Evaluation, Treatment, and Outcomes. Semin Intervent Radiol. 2016 Dec;33(4):268-276.
[5] Ng et al. Incidence and management of choledocholithiasis on routine intraoperative cholangiogram: a 5-year tertiary centre experience. ANZ J Surg. 2023 Jan;93(1-2):139-144.
[6] Lee et al. Prevalence and characteristics of clinically significant retained common bile duct stones after laparoscopic cholecystectomy for symptomatic cholelithiasis. Ann Surg Treat Res. 2016 Nov;91(5):239-246.
[7] Lyu et al. Laparoscopic common bile duct exploration plus cholecystectomy versus endoscopic retrograde cholangiopancreatography plus laparoscopic cholecystectomy for cholecystocholedocholithiasis: a meta-analysis. Surg Endosc 33, 3275–3286 (2019).
[8] KT Chittibabu, P Darwin, K Kuberan. A Study on Incidence of Choledocholithiasis in Case of Gall Stone Disease, J Res Med Dent Sci, 2021, 9 (4): 411-414.
[9] Matsui et al. Bile Duct Stones Predict a Requirement for Cholecystectomy in Older Patients. World J Surg 44, 721–729 (2020).