Skip to main content

Choledocholithiasis

Ali A. Khan, MD, MPH and Marie L. Borum, MD, EdD, MPH Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Stones in common bile duct (CBD)

  • Several types: cholesterol (majority), calcium bilirubinate or pigment, and mixed stones

  • System(s) affected: gastrointestinal; hepatobiliary

  • Synonym(s):...

DIAGNOSIS

HISTORY

  • Asymptomatic (30–50%)

  • Right upper quadrant (RUQ) pain:

    • Moderate/intense spasmodic pain, often intermittent, transient, recurrent (biliary colic)

    • May radiate to right shoulder/back, not r...

TREATMENT

Goal is to relieve obstruction. If not symptomatic, small stones may pass spontaneously. 

MEDICATION

Antibiotics if infection is suspected—cover enteric flora. 
  • Initiate broad-spectrum antibiot...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

After endoscopic bile duct clearance, patients should undergo cholecystectomy within 1 week. 

Patient Monitoring

  • Serial liver function tests and bilirubin levels, W...

REFERENCES

1
Maple JT, Ben-Menachem T, Anderson MA, et al; for ASGE Standards of Practice Committee. The role of endoscopy in the evaluation of suspected choledocholithiasis. Gastrointest Endosc.  ...

ADDITIONAL READING

  • Abdelmajid K, Houssem H, Rafik G, et al. Open choldecho-enterostomy for common bile duct stones: is it out of date in laparo-endoscopic era? N Am J Med Sci.  2013;5(4):288–292.

  • ...

SEE ALSO

Cholangitis, Acute; Cholecystitis; Cholelithiasis 
Algoritm: Jaundice 

CODES

ICD10

  • K80.50 Calculus of bile duct w/o cholangitis or cholecyst w/o obst

  • K80.51 Calculus of bile duct w/o cholangitis or cholecyst w obst

  • K80.40 Calculus of bile duct w cholecystitis, unsp, w/o obs...

CLINICAL PEARLS

  • Stones in the CBD are either primary (originate within the CBD) or secondary (migrate from the gallbladder).

  • Cholangiography is gold standard for diagnosis.

  • MRCP is the most accurate non...

Subscribe to Access Full Content

Sign Up for a 10-Day Free Trial

Sign up for a 10-day FREE Trial now and receive full access to all content.

 
×