Common Bile Duct Stones – Choledocholithiasis

Common bile duct stones or choledocholithiasis is the presence of gallstones in the common bile duct. Gallstones are concretions of cholesterol and other pigments that are present in the gallbladder. Sometimes these gallstones slip into the bile duct to form Common Bile Duct (CBD) stones. However, in 5% of patients with CBD stones, these stones can form primarily.

What causes choledocholithiasis?

15% of people will gallstones, will form stones in the CBD. There are two kinds of gallstones that primarily form in the CBD. They are stones made out of cholesterol and pigment stones. The most common type of gallstones formed is usually cholesterol stones which are caused by bile that contains too much cholesterol, bilirubin or not enough bile salts.

They may also occur if the gallbladder does not empty often or completely enough.

The cause of the pigment stones is not known but they seem to occur in people who have cirrhosis, biliary tract infections or hereditary blood disorders in which the liver makes too much bilirubin.

Other causes of CBD stones may include:

  • Obesity
  • Low calorie and rapid weight loss diets
  • Prolonged fasting
  • Increased level of oestrogen
  • Hormone therapy
  • Birth control pills

Who are at risk of CBD stones?

People with a history of gallstones or gallbladder diseases are at a risk for bile duct stones. Women are twice likely to be affected by this than men. It is a common condition, which can be experienced by people who have had their gallbladders removed.

People who are at risk for CBD stones are:

  • People who are overweight
  • Women and Men aged 20-60
  • Older adults aging over 60 have a higher risk for gallstones
  • People who lose weight quickly or have a crash diet
  • Pregnant women
  • Family history of gallstones

Symptoms of CBD stones

Some people may be asymptomatic and experience something called ‘silent stones’ which can go unnoticed for months or years. People may have gallstones, but not experience any symptoms which do not require any treatment. These stones can go unnoticed until they start causing symptoms such as:

  • Acute pain that occurs suddenly which can last a few minutes or hours
  • Pain may occur in your right upper abdominal area
  • Pain between your shoulder blades
  • Chills and fever
  • Jaundice
  • Nausea and vomiting

These gallstones can cause complications by blocking the pathway from the cystic duct. They may also interfere with the flow of digestive fluids into the small intestine which can cause inflammation of the pancreas. Prolonged blockage can cause severe damage to the gallbladder, liver or pancreas which can be fatal.

Common Bile Duct stone diagnosis

These stones can be diagnosed using methods such as an ultrasound, CT scan or sometimes an MRCP. Each diagnostic procedure has its own advantages, the most common one is an ultrasound which uses sound waves to create images of the organs, including the gallbladder. The waves are bounced off of the stones, revealing their location and their presence.

Some of the advantages of an ultrasound imaging test are that is non-invasive, painless and does not involve radiation.

Sometimes your physician might advise you to take other tests to detect small stones or verify their non-existence. Further then, MRCP/MRI or a CT scan may be recommended.

Laser treatment for Common Bile Duct stones

Treatment is advised when these stones become symptomatic and cause discomfort and disruptions to one’s normal life. They can be treated quickly and easily through laser treatment at chennai laser gastro - the best piles treatment hospital in India.

The common bile duct stones are treated through a laparoscopic route using the Holmium Yag Laser. It is more minimally invasive and makes up 95% of all cholecystectomies performed.

It is done with several small incisions in the abdomen to allow the insertion of a laparoscope. The surgeon is provided with a small video camera and uses the laser to treat the stones. This method does not require any abdominal muscles to be cut which results in less pain, quicker healing and fewer complications.

You may be advised to stay overnight in the hospital and may take several days to heal. Your physician may advise you to follow moderate physical activities and dietary changes to prevent the return of these stones in the future.

Dr. Karthik Gunasekaran

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