Dr. Aditya Kulkarni is a Consultant Laparoscopic and Robotic Gastrointestinal, Hepato-biliary-pancreatic and Cancer Surgeon at the renowned Ruby Hall Clinic,
STONES IN THE BILE DUCT (Choledocholithiasis)
Occurrence of gallstones in the common bile duct is called choledocholithiasis. The bile duct is a tube that is responsible for carrying bile from the gall bladder to the intestine. Most gallstones are formed in the gall bladder. They may pass through the cystic duct into the common bile duct, where they may obstruct the duct. They are made up of calcium or bile pigments and cholesterol salts.
Types of gallstones
There are predominantly two main types of gall stones: cholesterol stones and pigment stones. Cholesterol stones are yellow in colour and constitute about 80% of the gall stones. Pigment stones are made of bilirubin and are small and dark.
Causes of gallstones
- Age: Increased risk of happening in older people
- Gender: Gall stones are common in women
- Diabetes: High levels of triglycerides
- Too much bile secretion
- Gall bladder does not empty
- Blood diseases: Sickle cell anemia
- Rapid weight loss: quick weight loss induces cholesterol production and leads to gall stones.
- Constant and cramping pain in upper right abdomen for 30 minutes either sharp or dull
- Loss appetite
- Clay-coloured stool
- Nausea and vomiting
- Liver function blood test: This blood test, if indicates an elevation in bilirubin, serum transaminases is a sign of common bile duct stones.
- ERCP: Endoscopic retrograde cholangiography views the narrowed area of the bile duct and extracts any stones present in it.
- Abdominal CT scan: x-rays are used to create cross-sectional pictures of the belly.
- Abdominal ultrasound: It is a type of imaging that examines the spleen, gall bladder, liver, pancreas, and kidneys in the abdomen.
- Endoscopic ultrasound: EUS is also called echo-endoscopy where a probe is inserted into the organ and an ultrasound obtains images of the organ in the abdomen.
- Magnetic resonance cholangiopancreatography: MRCP is a technique which uses non-invasive resonance imaging to view the biliary ducts and if gall stones are present in the gall bladder.
- Percutaneous transhepatic cholangiogram: PTCA provides x-ray of the bile ducts.
Treatment of common duct stones
Bile duct stones are typically removed using endoscopic retrograde cholangiopancreatography (ERCP), a minimally invasive procedure that combines x-ray and upper endoscopy—an exam of the upper gastrointestinal tract, consisting of the esophagus, stomach and duodenum (the first part of the small intestine)—using an endoscope, which is a lighted, flexible tube. Majority of common bile duct stones can be removed endoscopically. In case ERCP is not possible, or fails to remove the stones, surgery is needed for removal. The surgery is known as common bile duct (CBD) exploration. It can be performed by open or laparoscopic technique. The gallbladder is usually removed in the same sitting. Some patients may require drainage of the bile duct into the small intestine or duodenum.