Common Bile Duct Stones

Bile duct stones are usually developed in the gall bladder which migrates to the bile duct or sometimes even forms in the bile duct primarily. Choledocholithiasis is the condition characterized by the presence of stones in the common bile duct. The bile duct is responsible for carrying bile from the liver and gallbladder to the intestine, which is responsible for digestion and fat absorption. The development of bile stones will cause hindrance in the proper flow of bile to the intestine, which in turn affects the digestion process.

Gall stones or bile stones are made up of cholesterol, bile salts and pigments which have solidified into stones. The size of the stones differs along with their numbers. Sometimes the stones may pass out of the bile duct spontaneously without any medical intervention. However, for the stones that are large and get stuck to the bile duct, proper treatment is necessary to prevent the inflammation, bacterial infection, and surrounding organ damage.

SYMPTOMS

Usually, bile stones may not cause any symptoms until they obstruct the duct. People may experience the below-mentioned symptoms  in severe cases such as :

• Fever
• Jaundice
• Abdominal pain mostly right or middle abdomen
• Loss of appetite
• Vomiting and nausea
• Greasy or light-coloured stools

Sometimes they also cause a severe bacterial infection in the liver known as ascending cholangitis. Biliary stones are also the cause of Acute Pancreatitis which may even be life-threatening.

DIAGNOSIS

Mostly bile duct stones can be diagnosed on the basis of symptoms and blood tests which indicate a high level of bilirubin and other liver enzymes. The other diagnostic tools that can be used to confirm the bile stones include the ultrasound, abdominal CT scan, endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP).

TREATMENT

The treatments mainly focus on relieving the blockage and might include various methods such as :

Endoscopic Technique –  miniaturized instruments can be passed through the ERCP that enlarge the duct opening in the duodenum and remove the stones. It is then followed by Laparoscopic Cholecystectomy.

Laparoscopic Cholecystectomy with CBD Exploration - In this technique along with the removal of the gall bladder, CBD is opened, stones retrieved and then the duct is sutured back usually over a stent.

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Blog reviewed by: Dr.Nikhil Agnihotri

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