Title: Choledocholithiasis: Clinical Manifestations and Associated Conditions
Authors: Dr M.Manimaran, Dr S.Chitra, Dr R.Balamurali, Dr S.Jeevan Kumar, T.P.Pugazhlendhi
DOI: https://dx.doi.org/10.18535/jmscr/v4i11.99
Background: More than 98% of all biliary tract disorders are in some way related to gallstones. Choledocholithiasis refers to the presence of gallstones within the common bile duct (CBD). It represent a clinical problem often involving severe infection, cholangitis and cholestasis. Investigations on the etiology of CBD stones are, however, scarce because of the difficult access to CBD stones and bile. In a clinical series of CBD stones, we studied the symptomatology and associated conditions of CBD stones. Methodology: A total number of 115 patients with CBD stones confirmed by imaging technique who underwent Endoscopic retrograde cholangipancreatography (ERCP) were included in this study and grouped as, Group 1- Patients with CBD stones with Gall Bladder (GB) stones. Group 2- Patients with CBD stones with no stones in GB. Group 3- Patients with CBD stones in postcholecystectomy state. Using standard proforma demographic and clinical details were collected. The statistical software package SPSS for Windows version 15 was used to analyse the data. Results: Out of 115 patients, 51 were males and 64 were females. Mean age of presentation was 49.91 years. Most common presentation of CBD stones was abdominal pain 60.86% followed by jaundice 38.26%.Charcots triad was seen in 33.04%. Most common associated condition was distal CBD stricture (16.5%). In this study 54% of patients had associated GB stones,22% had isolated CBD stones and 24% had CBD stones in postcholecystectomy state. Conclusion: There was no statistically significant difference in clinical presentations, associated features in all the three groups of choledocholithiasis. (P value > 0.238). Keywords: Choledocholithiasis, Common bile duct stones, Endoscopic retrograde cholangiography, Endoscopy and Jaundice.
3. Cynthia W. Ko, Sum P. Lee. Common bile duct stones: epidemiology, natural history, prediction of disease. Gastrointestinal Endoscopy. 2002;VS 56: NO. 6 (SUPPL) page 165-5. 4. Kumar D, Garg PK, Tandon RK.Indian J Gastroenterology. 2001 Sep-Oct;20(5):187-90. 5. Rakesh K Tandon. Prevalence and type of biliary stones in India. World J Gastroentero,2000;6(Suppl 3):4-5. 6. A. J. Sheen, S. Asthana, A. Al-Mukhtar, M. Attia, G. J. Toogood. Preoperative Determinants of Common Bile Duct Stones during Laparoscopic Cholecystec-tomy. Int J Clin Pract. 2008;62(11):1715-1719. 7. Schirmer BD, Winters KL, Edlich RF. Cholelithiasis and cholecystitis. J Long Term Eff Med Implants. 2005;15(3):329-38. 8. Förster S, Klar E. Common bile duct stones. Diagnostic and therapeutic mana-gement. Chirurg. 2008 Sep;79(9): 881-92. 9. Jeon WJ, Han JH, Seo JC, Park SM, Chae HB, Youn SJ. Clinical features of patients with choledocholithiasis showing high levels of aminotransferases. Korean J Gastroenterol. 2006 Mar;47(3):213-7. 10. Tazuma S. Gallstone disease: Epidem-iology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Clin Gastroenterol. 2006;20:1075-1083. 13. Madden JL. Common duct stones. Their origin and surgical management. Surg Clin North Am 1973;53:1095–113. 14. Lapo Bencini, Cinzia Tommasi, Roberto Manetti and Marco Farsi. Modern approach to cholecystocholedocholi-thiasis. World J Gastrointest Endosc. 2014 February 16; 6(2): 32-40. 15. Carlson GL1, Rhodes M, Stock S, Lendrum R, Lavelle MI, Venables CW. Role of endoscopic retrograde cholangio-pancreatography in the investigation of pain after cholecystectomy.Br J Surg. 1992 Dec;79(12):1342-5. 16. Andrews S1. Gallstone size related to incidence of post cholecystectomy retained common bile duct stones. Int J Surg. 2013;11(4):319-21. 17. Onken JE, Brazer SR, Eisen GM, Williams DM, Bouras EP,DeLong ER, et al. Predicting the presence of choledochol-ithiasis in patients with symptomatic cholelithiasis. Am J Gastroenterol 1996; 91:762-7.
Abstract