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PubMed1990

[Choledocholithiasis: risk factors and their significance for pre- and intraoperative diagnosis].

In 19% of the cholecystectomies done for acute cholecystitis, cholangitis and/or jaundice, an operative cholangiogram could not be obtained, usually because of considerable local inflammatory changes. This was the case in only 1.7% of the operations for uncomplicated cholelithiasis. Surprisingly high was the 31% rate of choledocholithiasis among the patients with complicated cholelithiasis, when compared to the 8% rate for operations in the complication-free interval. If a cholangiogram could not be obtained, exploration of the choledochal duct also was renounced. So patients with residual choledochal stones had to be expected, and in fact became symptomatically within the five years of follow-up.

Adult↗
PubMed1989

[Endoscopic papillotomy in the treatment of choledocholithiasis--technic, indications, results].

UNLABELLED: Endoscopic papillotomy (EPT) has good short- and long-term results in the non-operative treatment of common bile duct stones. Advantages are low risk, short hospital stay and short unfit to work. On the basis of the literature and own experiences that derive from 2,500 EPT the author discusses preparation, technique, indications, contraindications, complications, and results of the procedure. EPT successfully had been performed in 98.3% of cases. All bile duct stones could be removed in 92%. INDICATIONS: choledocholithiasis 2013 (456 with gallbladder in situ, 24 with acute biliary pancreatitis), benign papillary stenosis 125, papillary carcinoma 57, other indications 305. COMPLICATIONS: 4.6% (115); bleeding 36, pancreatitis 36, cholangitis/stone impaction 30, retroduodenal perforation 13; urgent operation 1.2% (30), mortality 0.5% (12).

Ampulla of Vater↗
PubMed1989

[Extrahepatic biloma secondary to choledocholithiasis].

We present a case of extrahepatic biloma in a patient who was an emergency admission to the hospital and had a clinical pattern of obstructive jaundice secondary to choledocholithiasis. The diagnosis was made by echography and needle aspiration (PAAF). Due to the unfavorable evolution of the patient in the 48 hours after admission, she underwent surgery, which confirmed the diagnosis. Cholecystectomy was performed, with removal of the choledochal gallstone and side-to-side choledochoduodenostomy, and the postoperative evolution was satisfactory. We review the pathophysiologic characteristics of this entity and its etiology, symptomatology, diagnosis and treatment.

Aged↗
PubMed1989

[Ultrasonics in the diagnosis of choledocholithiasis].

The value of ultrasound in the diagnosis of choledocholithiasis is controversial, sensitivity figures ranging from 22 to 75%. We correlated the ultrasound study with operative findings in 38 patients. A diagnosis of common bile duct stone was made upon finding an echogenic image with or without acoustic shadow in the common bile duct; no attention was paid to the dilatation of the biliary tree. The sensitivity was 68% and the positive predictive value was 85%. Therefore, our results approach the highest reported figures for the value of this diagnostic technique.

Evaluation Studies as Topic↗
PubMed1988

Sonography of gallstones and biliary dilatation without a visible aetiology: the infrequency of obstructing choledocholithiasis.

This paper describes 50 consecutive patients who sonographically had gallbladder stones and dilated bile ducts, but no visible aetiology for the dilatation. We reviewed these cases to determine the frequency of choledocholithiasis in this setting. Common duct stones caused obstruction in only 36% of these patients. Other aetiologies included strictures due to chronic pancreatitis or prior stone passage in 24% of the patients, and malignant obstruction in 16%. In 24% of the patients, no cause was found for biliary dilatation; common duct stones or obstructing tumours were excluded in the group. Since aetiologies other than stones are likely in a majority of cases, further preoperative workup (CT, percutaneous transhepatic cholangiography, ERCP) or intraoperative cholangiography (if the patient requires urgent cholecystectomy) is indicated. The additional studies should provide a diagnosis, help determine whether or not the common duct should be explored, or avoid unnecessary operation in case of incurable malignancy.

Adult↗
PubMed1986

Endoscopic papillotomy in the management of choledocholithiasis.

Endoscopic papillotomy was attempted in 72 patients with common bile duct stones, 47 of whom previously had been cholecystectomized and 25 with their gallbladder still present. Papillotomy was successful in 69 patients (96%) and the duct was cleared of stones in 63 (88%). Nine patients thus needed elective surgery. There was no mortality following papillotomy and no grave complication occurred. On the follow-up, from 5 months to 10 years (mean 4 years), only one of the 63 patients with successful papillotomy has required operation. Endoscopic papillotomy is effective for treating many patients with choledocholithiasis, both in those following cholecystectomy and in those with gallbladders in situ.

Adult↗
PubMed1987

Obstructive jaundice and cholangitis due to choledocholithiasis: treatment by extracorporeal shock-wave lithotripsy.

Endoscopic shock-wave lithotripsy, although now the standard treatment of urolithiasis, has only recently been applied to cholelithiasis. The authors describe the case of an 88-year-old man, a high-risk patient with choledocholithiasis, in whom endoscopic stone extraction after sphincterotomy failed. Extracorporeal shock-wave lithotripsy was used for noninvasive stone fragmentation and the fragments were passed without complication.

Aged↗
PubMed1986

Can acute cholecystitis produce obstructive jaundice in the absence of choledocholithiasis?

A case is presented of acute cholecystitis that produced extensive ascending, intrahepatic acute cholangitis (sufficient to produce obstructive jaundice of significant degree) without evidence of choledocholithiasis or ductal dilatation.Questions are raised concerning the present accepted clinical classification of both cholangitis and obstructive jaundice.

Acute Disease↗
PubMed1985

[Endoscopic fistulotomy in choledocholithiasis].

In 9 cases of choledocholithiasis and 2 cases of endoscopically determined stenosis of the papilla in which an EPT could not be successfully performed it was possible to carry out a prepapillary choledochoduodenal fistula by means of endoscopy. Subsequently the fistula was split in the cranial direction using a papillotome, i.e. a fistulotomy was performed. The choledochal concrements disappeared spontaneously and the patients recovered successfully. In 4 further cases with an occlusion icterus, but with narrow ductus choledochus the common bile duct could not be cannulated. The endoscopic fistulotomy is only indicated when the common bile duct is dilated and if prior to the procedure and after failure of ERCP the indication for a surgical intervention is established through sonography or even better through PTC.

Aged↗
PubMed1984

Choledocholithiasis in a horse.

Choledocholithiasis was diagnosed in a five-year-old gelding on the basis of laboratory results and histopathology. Surgery was performed to relieve the obstruction. The horse responded favorably and at 39 days postoperatively was clinically and clinicopathologically normal.

Animals↗
PubMed1983

Consequences of preoperative cholangitis and its treatment on the outcome of operation for choledocholithiasis.

During a 30-month period 73 patients underwent operation for choledocholithiasis. Thirty-three of these patients (45%) had cholangitis preoperatively. When compared to patients with common duct stones who had no preoperative cholangitis, patients with cholangitis were older (P less than 0.001), more likely to present with jaundice (P less than 0.01) and leukocytosis (P less than 0.01), and more likely to have retained or primary common duct stones (P less than 0.01). Cholangitis patients were also more likely to have bactibilia (P less than 0.025), and anaerobes were isolated from the bile of 27% of these patients (P less than 0.01). Twenty-nine of 33 cholangitis patients (88%) received a minimum of 4 days of broad-spectrum antibiotics including an aminoglycoside prior to operation (P less than 0.01). Despite these clear differences, patients with preoperative cholangitis were not more likely to develop infective sequelae or biliary complications. However, cholangitis patients were much more likely (P less than 0.001) to develop an increase in serum creatinine (33% versus 3%) which, in turn, contributed to a longer (P less than 0.01) postoperative hospitalization. Since therapy with aminoglycosides may have contributed to postoperative morbidity and prolonged hospital stay, aminoglycosides should be reserved only for patients with the most severe cholangitis and should be used with great caution.

Adolescent↗
PubMed1983

Incidence and significance of primary stones of the common bile duct in choledocholithiasis.

To assess the significance of primary common bile duct stones as an index predisposing to recurrent choledocholithiasis, 522 patients who underwent choledochotomy are presented in this study for further discussion. There was an association of primary common bile duct stones with bile infection, with an increased incidence of anaerobes in bile cultures and with an advanced inflammatory infiltration of the biliary tree. Furthermore, primary common bile duct stones have an increased incidence in patients with a long history of symptoms of the disease, of advanced age and who have had previous biliary surgical treatment. Primary stones are an index of existent biliary stasis and have to be taken into serious consideration in dealing with patients suffering from biliary lithiasis.

Adult↗
PubMed1978

Jaundice, choledocholithiasis, and a nondilated common duct.

In two cases of jaundice due to choledocholithiasis, the biliary tree was not dilated on skinny-needle transhepatic cholangiography. Visualization of the biliary tree before arriving at a diagnosis in certain cases of jaundice is needed.

Cholangiography↗
PubMed1981

Treatment of choledocholithiasis with oral chenodeoxycholic acid.

The aim of this study was to conduct a controlled trial of oral chenodeoxycholic acid in the management of radiolucent choledocholithiasis. Thirteen patients were randomized in double-blind fashion to receive either 750 mg/day of chenodeoxycholic acid (CDCA) or a placebo. After 4 months, those who had the placebo were administered CDCA; those who had received CDCA and showed a 25% or more decrease in the size of stones (evaluated blindly) received CDCA for an additional 4 months. Five of the 13 patients did not complete the study; four (one initially placebo and three CDCA) because acute biliary symptoms mandated operative intervention and one (initially placebo, then CDCA) because of asymptomatic elevations of the serum transaminase levels. Patients who were withdrawn from the study had significantly larger stones (P less than 0.02) (mean largest diameter, 11.4 mm +/- 1.6 SEM) than those who completed the study (6.5 +/- 0.5). Of the eight patients who completed the study, two of the three who received CDCA initially for 6 to 8 months experienced complete disappearance of stones; all five patients who took the placebo failed to show dissolution, and one of these subsequently had dissolution of stones after 8 months of CDCA. Biliary lipid analyses during treatment showed bile unsaturated with respect to cholesterol in the three patients whose stones dissolved with CDCA therapy. In conclusion, a patient with partial dissolution of stones and unsaturated bile after 4 months of CDCA probably will have complete dissolution of stones after 6 to 8 months of CDCA.

Administration, Oral↗
PubMed1981

Controversies in biliary drainage for choledocholithiasis and cholangiohepatitis in Singapore.

Although fulminating primary cholangitis appears to be less frequently seen in recent years in Singapore, choledocholithiasis continues to be frequently encountered. A proportion of these patients probably represents the less severe forms of primary cholangiohepatitis with primary ductal calculi. These calculi are related to stasis within the bile ducts and an internal biliary drainage procedure appears logical and should be performed. There is a place for each of the drainage procedures, choledochojejunostomy, choledocho-duodenostomy and sphincteroplasty in the treatment of primary duct calculi and cholangiohepatitis. Choledochoduodenostomy is simple, safe and particularly suitable for elderly and poor risk patients and in emergency situations. Sphincteroplasty has the advantage of dependent drainage, permits removal of impacted calculi and may be suitable when the common bile duct is not grossly dilated. Clearer understanding of the pathogenesis of biliary calculi and primary cholangiohepatitis is important to foster a more logical approach in the treatment of the disease.

Aged↗