Dilated Ducts: Is It a Reliable Sign for Choledocholithiasis in Patients with Acute Calculous Cholecystitis (ACC)?

Abstract

BACKGROUND: In patients presenting with ACC common bile duct (CBD) stones need to be ruled out prior to surgery. Besides other variables, the degree of CBD dilation may be a predictive factor for presence of CBD stones and may help decide need for pre-operative ERCP. AIMS: To study the correlation between the size of the common bile duct and presence of CBD stones in patients with ACC. METHODS: All cases with ACC and cholelithiasis undergoing ERCP were studied. Size of the CBD as measured during ERCP was used to calculate the probability of CBD stones (Chi square and T tests). Balloon sweep was used as gold standard to check for the presence or absence of stones. RESULTS: Three hundred and forty-five patients with ACC undergoing ERCP for presumed CBD stones during last 5 years were studied. Of the 345 patients (male=200, female=145, mean age=49) 218 were found to have CBD stones while 127 did not have the stones. Using the Chi square test there was no correlation found between the duct diameter and presence of CBD stones (table). Using the T test analysis CBD, size was not found to be a reliable predictor of CBD stones (table). CONCLUSIONS: In patients with acute calculus cholecystitis and non dilated CBD, CBD size alone cannot be used to rule out the presence of CBD stones. In patients with dilated ducts, CBD size alone may not be a good predictor of presence of CBD stones and other variables should be taken into consideration for decisions for ERCP prior to cholecystectomy.