CBD Stone / Choledocolithiasis

Introduction
Common Bile Duct (CBD) is a tube that carries bile from gallbladder or liver to
the small intestine. CBD stone also known as duct stone or choledocolithiasis is
a presence of a gallstone in the common bile duct. Gallstone usually forms
inside the gallbladder which is a pear shaped organ below the liver. These
stone usually remains in gallbladder however sometime it migrates into
common bile duct and gets tucked obstructing the passage this condition is
called choledocolithiasis or CBD stone.

Signs & Symptoms

CBD stones may not have any signs & symptoms for months or even years.
However, if the blockage becomes severe, the following signs & symptoms may
be experienced:

Pain in the upper or middle part of abdomen

Fever
Jaundice
Loss of appetite
Nausea & vomiting

Causes
Gallstone may develop when there is too much cholesterol or bilirubin inside
gallbladder secreted by the liver.
Too much cholesterol: Bile usually dissolves or break down cholesterol however
if the liver produces more cholesterols than the bile can dissolve it results in
formation of hard stones called cholesterol gall stones.
Too much Bilirubin: Bilirubin is a chemical that is produced when the body
breaks down old red blood cells. In some cases such as cirrhosis of the liver and
certain blood disorders the liver produces too much bilirubin which contributes
to the gallstone formation.
Poor emptying of Gallbladder: If the gallbladder often fails to get empty
completely the bile may becomes overly concentrated leading to formation of
gallstones.

Dr. Sanjiv Haribhakti

Gisurgery.info

Risk Factors
Following are the risk factors of developing CBD stone:

Obesity
Prolonged fasting
Rapid weight loss
Lethargic lifestyle
Pregnancy
Age & Gender: older people and women are more likely to have CBD stone
Family history of gallbladder disease

Complications
Acute Cholangitis: CBD stone can cause infection in the bile. The bacteria
from the infection can spread rapidly. It can move into the liver or ductal
system. It can become a life threatening infection
Hepatic Abscess
Billiary cirrhosis
Pancreatitis

Diagnosis
Abdominal CT Scan: it is a digital imaging test that takes pictures of the liver
and abdominal region revealing the presence of gallstone if any.
Ultrasound: this test uses ultrasonic sound waves to create image of abdominal
organs which help find presence of any gallstone.
Endoscopic Ultrasound (EUS): an ultrasound probe is inserted on a flexible
endoscopic tube and inserted through mouth to examine the digestive tract.
Endoscopic Retrograde Cholangiography (ERCP): it is a procedure used to
identify stones, tumors and narrowing in the bile ducts. An endoscopic tube is
inserted through the mouth and dye is injected into the ducts where they can
be visualized with x rays.
Magnetic Resonance Imaging (MRI): MRI scans of the gallbladder, bile ducts
and pancreatic duct called Magnetic Resonance Cholangiopancreatography
(MRCP).
Blood tests: to look for amount of bilirubin in the blood and to determine the
functioning of liver.

Treatment
The treatment of CBD stone includes one or more of following:
Stone extraction
Dr. Sanjiv Haribhakti

Gisurgery.info

 Lithotripsy: breaking the stone into small pieces allowing them to pass
through
Cholecystectomy: surgery to remove gallbladder and stone
Sphincterotomy: surgery to make a cut into the common bile duct to remove
stones or help them pass
Biliary stenting
Laparoscopic CBD exploration
Endoscopic Sphincterotomy is the most common treatment of CBD stone.
During this procedure a balloon or basket type device is inserted into the bile
duct and used to extract the stones.
Lifestyle changes such as physical activity and dietary changes such as
increasing fiber and decreasing saturated fats can reduces the chances of
developing CBD stones.

Dr. Sanjiv Haribhakti

Gisurgery.info