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

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 Open choldecho-enterostomy for common bile duct stones: is it out of date in laparo-endoscopic era?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.
...

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

START 10-DAY FREE TRIAL

Subscribe Now

Forgot password?

Enter an Access Code

GET CME/CE