Choledocholithiasis

Choledocholithiasis occurs when gallstones, often from the gallbladder, lodge in the common bile duct (CBD), blocking bile flow from the liver to the intestine. These stones, mainly cholesterol or pigment-based, affect 1-15% of cholelithiasis patients. Untreated, it risks cholangitis, pancreatitis, or liver damage.

Causes and Risks

Primary stones form directly in the CBD due to bile stasis, infections, or imbalances in bilirubin and cholesterol. Secondary stones migrate from the gallbladder, linked to obesity, diabetes, high-fat diets, and genetics. Women, elderly, and those with rapid weight loss face higher risks.

Symptoms

Sudden right upper abdominal pain radiating to the back, jaundice, fever, nausea, and pale stools signal obstruction. Asymptomatic cases occur in 45% initially, but complications like biliary colic arise if blocked.

Diagnosis and Treatment

Ultrasound, MRCP, or ERCP confirm stones; blood tests show elevated bilirubin and enzymes. ERCP with sphincterotomy removes stones effectively, often followed by cholecystectomy. Surgery suits complex cases; timely intervention yields favorable prognosis with low recurrence.