Choledocholithiasis – What is it, Causes, Symptoms and Treatments!

Choledocholithiasis – What it is, Causes, Symptoms and Treatments of this condition. Also, Choledocholithiasis is a pathological condition where there is formation of stones in the common bile duct . Usually, stones develop in the gallbladder , but sometimes the stones pass the gallbladder into the common bile  duct  , thus blocking the bile duct , causing numerous symptoms.

The bile duct  is a tube that connects the gallbladder  to the small intestine . Research suggests that approximately 20% of people who have cell stones go on to develop choledocholithiasis .

Causes of Choledocholithiasis: About 1 in 7 people with gallstones will develop common choledocholithiasis . This is the small tube that carries bile from the gallbladder to the intestine . Risk factors include a history of gallstones. However, choledocholithiasis can occur in people who have had their gallbladder  removed.

Symptoms of Choledocholithiasis: Here are the most prominent symptoms of Choledocholithiasis . If the stone becomes blocked there is a greater chance of infection in the biliary tree . This can quickly spread to the liver and other organs which can be dangerous.

• Severe pain in the right and upper middle quadrant of the abdomen.
• Vomiting and nausea.
• The pain may radiate to the back and right shoulder.
• fever _
• Jaundice.
• Loss of appetite .
• Clay stools.

Diagnosis of Choledocholithiasis: The diagnosis of Choledocholithiasis  is made through:

• Liver function tests
• ultrasound

Choledocholithiasis should be suspected in patients with jaundice and biliary colic . Fever and   leukocytosis also suggest acute cholangitis. Elevated levels of bilirubin and particularly alkaline phosphatase, ALT, and gamma-glutamyltransferase are consistent with extrahepatic obstruction, suggesting stones, particularly in patients with features of acute cholecystitis or cholangitis.

Ultrasound may show stones in the gallbladder  and occasionally in the common duct (less accurate). The common duct is dilated (> 6 mm in diameter if the gallbladder  is intact, > 10 mm after a cholecystectomy). If the ducts are not dilated at the beginning of the presentation (eg, day one), the stones have likely passed.

If in doubt, magnetic resonance cholangiopancreatography (MRCP) is highly accurate for retained stones. ERCP is done if the MRCP is equivocal; It can be therapeutic as well as diagnostic. CT, although less accurate than ultrasound, can detect liver abscesses.

Treatments For Choledocholithiasis: These are the main means of treating Choledocholithiasis :

• stone extraction
• lithotripsy
• cholecystectomy
• sphincterotomy

Of the above mentioned treatment options, the most preferred method to treat choledocholithiasis  is endoscopic biliary sphincterotomy . In this procedure, a device is inserted into the bile duct  and is used to extract the stones. This procedure has a success rate of about 90%, which means that in about 90% of people all stones are successfully removed by this procedure.

In case the bile duct stones cannot be removed by endoscopic biliary  sphinterotomy , then the doctor may recommend attempting lithotripsy. In this procedure, the stones are first fragmented and then captured.