Bile Duct Stones

Abstract

In patients with choledocholithiasis gallstones can be located in the extraas well as in the intrahepatic bile ducts. Bile duct stones can be cholesterol concrements, and black and brown pigment stones. Cholesterol and black pigment stones exclusively originate from the gallbladder and therefore are called secondary bile duct stones. The brown calcium-bilirubinate stone is a primary bile duct stone, which originates from the bile ducts. In East Asia, brown bilirubinate stones can also be found in the gallbladder, but in Europeans it is extremely rare. The relative frequency of bile duct stones is 23% and increases with age as it does for gallbladder stones. In 30 years old persons it amounts to 5%, in 60 years old persons to 15% and in the 80th year of life to 50%. In 70–80%, bile duct stones are secondary concrements. Since these stones originate from the gallbladder they all have the characteristic cubic, pyramid-like or polygonal shape and can easily be identifi ed as secondary bile duct stones. Fifteen percent of all patients with cholecystolithiasis simultaneously have bile duct stones and 80–95% of patients with bile duct stones have gallbladder stones. Primary bile duct stones are round, cylindrical and layered due to their appositional growth and adapt their shape to the shape of the bile duct. Primary bile duct stones mostly develop after endoscopic or surgical manipulations of the biliary tree, and since bile duct stones proximal to stenoses, strictures or tumorous alterations as well as chronic infl ammation are diffi cult to treat, primary gallstones tend to recur. Also, after endoscopic sphincterotomy bile duct stones can develop if the sphincterotomy was not large enough, when extraand intrahepatic bile ducts are dilated, and the patient is of older age. Chapter Outline