Choledocholithiasis management

Choledocholithiasis management

Choledocholithiasis is gallstone lodged in the common bile duct (CBD). It occurs in some patients with gallbladder stones and can form de novo in the CBD.

Clinical presentation

• Asymptomatic

• Right upper quadrant (RUQ) pain

• Epigastric pain due to obstruction of bile flow which leads to increase in CBD pressure

• Jaundice

• Pruritus

• Nausea

Investigations

• Liver function tests (LFT)

• Amylase

• Lipase

• Abdominal (RUQ) ultrasound

• ERCP, if ERCP unavailable or unsuccessful:

  • Endoscopic ultrasound (EUS)

  • Magnetic resonance cholangiopancreatography (MRCP)

Non-pharmacological treatment

• ERCP and papillotomy with stone extraction (± lithotripsy)

• Cholecystectomy typically within 6 weeks unless contraindication

Pharmacological treatment

• Cholestyramine (PO) 4–8 g 12 hourly when required for itching

Complications

• Cholangitis

• Cholecystitis

• Pancreatitis

• Stricture