Choledocholithiasis

Choledocholithiasis is a form of complicated gallstone disease characterised by a gallstone stuck in the common bile duct. It causes cholestasis, and may lead to cholangitis, a severe bacterial infection or acute biliary pancreatitis.

Clinical features

Patients presents with biliary colic-like pain, but choledocholithiasis pain usually lasts longer. Jaundice may be present.

Diagnosis and evaluation

Laboratory investigations show signs of cholestasis, including hyperbilirubinaemia and elevated ALP/GGT. Unlike in cholangitis, there are no laboratory signs of inflammation.

Imaging, usually ultrasound, is indicated to visualise the obstruction.

Treatment

Removal of the obstruction, usually by ERCP, is indicated. Cholecystectomy is indicated to prevent future occurances.