About Choledocholithiasis
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Choledocholithiasis is the presence of a gallstone in the common bile duct (CBD)
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About 15% of people with gallstone will develop stones in the CBD. CBD stones have been discovered days to several years after patients with cholecystectomy.
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It is believed the stones represent either retained stones or stones that have formed de novo after the operation.
Symptoms
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Sudden, severe pain in middle upper abdomen
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Pain may radiate to right shoulder
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Occasionally painless
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Fever
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Chills
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Nausea/vomiting
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Severe case may sepsis
Diagnosis and test
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ERCP (endoscopic retrograde cholangiography)
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Abdominal CT scan
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Abdominal ultrasound
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Percutaneous transhepatic cholangiogram
Laboratory Findings
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Elevated Bilirubin level
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Bilirubin in urine
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Elevated Alkaline phosphatase
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Possible elevated Amylase
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Possible elevated ALT, AST (liver tests)
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Possible prolonged Prothrombin time
Treatment
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Antibiotics intravenous injection
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Stone removal by ERCP
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Percutaneous transhepatic cholangic drainage(PTCD): can be used for emergent drainage of the biliary tree in the presence of cholangitis. The tube is left for stone removal.
About percutaneous extraction of biliary calculi
Removal of retained calculi within the biliary system after surgery through the T-tube tract. The procedure can also be performed through a percutaneous biliary drainage tract.
Indications
Removal of retained calculi within the biliary system, typically after receiving Cholecystectomy.
Contraindications:
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An immature tract
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Coagulopathy
Patient Preparation
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The procedure can be performed on an outpatient basis.
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The patient is fasting 4 hours before the procedure.
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An intravenous line might be set to ensure adequate hydration and to facilitate the administration of any sedatives during the procedure.
After Care
The patient is observed for 30-60 minutes and can be discharged if no untoward symptom is reported.
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