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Choledocholithiasis

Ali A. Khan, MD, MPH and Marie L. Borum, MD, EdD, MPH, MACP, FACG, AGAF Reviewed 06/2019
 


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...

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 antibioti...

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

  • Cox MR, Eslick GD, Padbury R, eds. The Management of Gallstone Disease: A Practical and Evidence-Based Approach. New York, NY: Springer; 2018. [View Abstract on OvidMedline]

  • Giljac...

SEE ALSO

  • Cholangitis, Acute; Cholecystitis; Cholelithiasis

  • Algorithm: Hyperbilirubinemia and 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...

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