Abstract
Background: Five to 20% patients with cholelithiasis also have choledocholithiasis. Most of them are diagnosed during a routine preoperative examination. Objective: To study the incidence of choledocholithiasis in patients with gallstone disease.
 Materials and methods: This is a retrospective observational study, conducted over a period of five years from January 2009 December 2013. Hospital record of the patients with a diagnosis of gallstone disease were evaluated. Clinical pictures of the disease and incidence of choledocholithiasis in those patients were analyzed.
 Result: One thousand four hundred sixty were diagnosed as a gallstone disease over a period of five years. Bile duct stone was found in 59 (4.04%) patients. The median age of presentation was 55 years. Classical charcots traid was seen in 9 (15.25%) patients. Ultrasound of the abdomen detected choledocholithiasis in 44 (74.57%) patients. Fifty four (91.52%) patients were managed with open cholecystectomy and CBD exploration.
 Conclusion: Incidence of choledocholithiasis in patients with gallstone disease is 4.04%. Most of the choledocholithiasis were diagnosed by ultrasound of the abdomen. Even in the era of minimally invasive surgery, when facilities and technical expertise are not available choledocholithiasis has to be managed with open CBD exploration.
Highlights
Choledocholithiasis refers to the presence of stones or sludge in the common bile duct and/or common hepatic duct
Eighty percent of the choledocholithiasis are secondary to the passage of stones from the gallbladder into the common bile duct[1], When the stone is formed primarily in the bile duct, called primary choledocholithiasis
Bile stasis promotes the growth of bacteria, deconjugate bilirubin, which later form insoluble calcium bilirubinate that leads to the formation of biliary sludge and stone formation
Summary
Choledocholithiasis refers to the presence of stones or sludge in the common bile duct and/or common hepatic duct. Eighty percent of the choledocholithiasis are secondary to the passage of stones from the gallbladder into the common bile duct ( called secondary choledocholithiasis)[1], When the stone is formed primarily in the bile duct, called primary choledocholithiasis. It accounts for about 20% of the choledocholithiasis[2, 3]. Bile stasis promotes the growth of bacteria, deconjugate bilirubin, which later form insoluble calcium bilirubinate that leads to the formation of biliary sludge and stone formation. Choledocholithiasis can cause obstruction to the bile duct, suppurative infection to the bile duct, pancreatitis, or secondary biliary cirrhosis after a long time and up to 3.8% have symptoms related to choledocholithiasis during the first year after cholecystectomy.[1]
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