Choledocolithiasis

In the body, bile is produced by the liver and is stored away in a sac call the gallbladder; the bile duct is responsible for carrying the bile from the gallbladder into the small intestine. Bile is necessary for digestion and absorption of fats. Choledocolithiasis consists in the total or partial obstruction of the bile ducts due to stones.

How are stones made?

The majority of stones found within the bile duct form within the gallbladder, and then migrate toward the duct. However, a small percentage of stones can form within the duct itself. Risk factors for the formation of gallstones are gender (more frequent in women), age (risk increases with age), family history and genetics, and some conditions such as pregnancy, obesity, intake of estrogen, rapid weight loss, diabetes, cirrhosis, or certain kind of medications.

What are the symptoms?

At times, choledocholithiasis can take place without any symptoms; however most cases lead to pain in the upper part and right side of the abdomen, along with jaundice (yellow coloring of the skin) and coluria (dark coloration of urine). If the obstruction of the duct results in bacterial infection, the outcome is a cholangitis (infection of the bile). At times, choledocolithiasis can cause inflammation of the pancreas when the stone also obstructs the pancreatic duct.

How is it diagnosed?

Physical examination and blood tests reveal alterations that may suggest the obstruction of the biliary duct, infection, or suspicion of pancreatitis. Imaging of the abdominal area can reveal signs of stone obstruction in the bile duct. Ultrasound is the most effective way to obtain detailed imaging of the abdomen and can confirm the diagnosis in 80% of the cases. In the rest of the cases, it is necessary to perform an MRI.

How is choledocolothiasis treated?

Treatment must take place in an urgent manner, particularly in the presence of infection. An ERCP (procedure that combines endoscopic view of the digestive tract with x rays) is the treatment of choice, allowing the removal of stones from the bile duct without the need for extensive surgery.

This technique relies on endoscopic view and x rays to perform an expansion of the opening to the bile duct in order to extract the stones. This procedure has a high rate of success and low risk of complications. Large stones too large to remove through the duct are fragmented. If fragmentation is unsuccessful, then surgery is considered. A small percentage of patients experience a second case of choledocholithiasis after removal of the first stone or stones. This risk decreases when patients with gallstones have their gallbladder removed.

Extraction of stones from the bile ducts by endoscopy.