Bile duct stone ( Choledocholithiasis):

• Choledocholithiasis is the presence of stones in the common bile duct. This is one of the complications of cholelithiasis (gallstones), About 15% of people with gallstones will develop stones in the common bile duct. Stone may also migrate from liver or form in the bile duct. This may cause obstruction of bile duct with jaundice and liver cell damage. It can also cause acute pancreatitis and ascending cholangitis.
• The common symptoms are abdominal pain in the upper right quadrant or the middle of the upper abdomen, nausea ,vomiting ,fever ,Jaundice and loss of appetite. illustration

The diagnosis of choledocholithiasis is suggested when blood test for liver function shows an elevation in serum bilirubin and serum alkaline phosphatase. In prolonged cases the Prothrombin time and INR may change due to a decrease in vitamin K absorption.

Diagnosis is made by abdominal ultrasound, which may show the stone(s) as acoustic shadows. in the bile duct .The duct may be of normal caliber or dilated due to blockage by stone or associated narrowing (stricture).

The diagnosis is confirmed with either an MRCP (Magnetic resonance cholangiopancreatography) or an ERCP (Endoscopic retrograde cholangio pancreato graphy) .

Treatment involves removing the stone(s) using ERCP. During ERCP the opening into the bile duct is widened ( pappilotomy) and stone removed . However, ERCP is an invasive procedure and has its own potential complications. When the stone (s) could not be removed by ERCP then bile duct stones are removed by open surgical method called choledocholithotomy. It is needed when the stone (s) are large enough or associated with biliary narrowing (stricture). Bile duct is opened, stone(s) removed, the distal and proximal biliary channel checked for complete clearance and free passage of distal bile duct is ensured. One tube (T- tube) placed in the bile duct which is subsequently removed in the postoperative period.

When there is extreme narrowing of distal bile duct or grossly dilated bileduct, then biliary enteric anastomosis ( Roux-en-Y hepatico Jejunostomy), a form biliary reconstruction is done to ensure uninterrupted bile flow from liver to intestine.

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