Abstract
BACKGROUND: Choledocholithiasis is a complication of gallbladder stones; only in a minority of the patients they arise de novo in the bile ducts. In the present study, we have attempted to enumerate the demographic characteristics, various modes of clinical presentation, diagnostic tests, management and complications of the patients with choledocholithiasis. METHODS: A prospective study was conducted from October 2009 to September 2011 (24 months including follow-up period) in patients diagnosed to have choledocholithiasis. Patients with intra-hepatic stones and biliary stricture were excluded from the study. Demographic characteristics, various modes of clinical presentation, investigations, management and complications of the patients with choledocholithiasis were studied. A total of 31 patients with a diagnosis of choledocholithiasis are included in this study. The patients were divided into two groups -Open Surgery (CBD exploration and cholecystectomy) and ERCP followed by Laparoscopic Cholecystectomy. RESULTS: Right hypochondrial pain was the most common clinical manifestation followed by jaundice and fever. Serum Bilirubin and Alkaline Phosphatase were in most cases. Ultrasonography was most important imaging modality failing which CT or MRI scans were indicated. ERCP with Endoscopic Sphincterotomy (ES) was done in 22 patients and was successful in 19 of them. 3 failures were due to impacted stones. 12 patients underwent open CBD exploration with cholecystectomy. Incidence of complications were significantly more and also the duration of Hospital stay was more in those who underwent open surgery. CONCLUSION: Ultrasonography has a sensitivity of 70.96% in detecting CBD calculi. Routine use of MRCP and CT is not required. ERCP with Endoscopic Sphincterotomy followed by laparoscopic cholecystectomy can be used for the treatment of CBD calculi. Complications are more in patients who undergo open surgery. There is a significant decreased mean hospital stay in patients who undergo endoscopic treatment.
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