2809 The Role of Serum Total Bilirubin Level Pattern in Predicting Spontaneous Passage of Common Bile Duct Stones

Gallbladder (GB) stones are commonly associated with common bile duct stones (CBDS). While they may remain asymptomatic, some may present with symptoms like biliary colic, jaundice and cholecystitis. Most of these stones in the CBD, if small, pass through faeces. Passing larger stones through faeces is relatively rare and if it does occur, is usually associated with fatal complications like acute pancreatitis. The authors reported a case wherein symptomatic large CBD stones were spontaneously passed through faeces and the patient was relieved of the symptoms and did not suffer any further complications. Choledocholithiasis is usually managed by endoscopic retrograde cholangiopancreatography or by laparoscopic or open choledocholithotomy. Spontaneous passage of small CBD and GB calculi through faeces although common is associated often with the development of pancreatitis. Passage of large CBD calculi (size >1.5 cm) through faeces is rarely seen.

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Role of endoscopic ultrasound in common bile duct stones

Saudi Journal of Gastroenterology ◽

10.4103/1319-3767.30459 ◽

2007 ◽

Vol 13 (1) ◽

pp. 11 ◽

Cited By ~ 4

Author(s):

AbdulrahmanM Aljebreen

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Endoscopic Ultrasound ◽

Common Bile Duct Stones ◽

Bile Duct Stones

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Total Bilirubin is a Useful Predictor of Persisting Common Bile Duct Stone in Gallstone Pancreatitis

The American Surgeon ◽

10.1177/000313480807401020 ◽

2008 ◽

Vol 74 (10) ◽

pp. 977-980 ◽

Cited By ~ 8

Author(s):

Tony Chan ◽

Arezou Yaghoubian ◽

David Rosing ◽

Edward Lee ◽

Roger J. Lewis ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Total Bilirubin ◽

Bile Duct Stone ◽

Total Bilirubin Level ◽

Serum Total Bilirubin ◽

Gallstone Pancreatitis ◽

Endoscopic Retrograde ◽

Cbd Stones ◽

Unnecessary Procedures

Accepted guidelines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are lacking. Our previous investigations suggested that serum total bilirubin on hospital Day 2 best predicts persisting common bile duct (CBD) stones. We aim to identify an optimal total bilirubin threshold on hospital Day 2 that would predict persisting CBD stones and guide obtaining preoperative ERCP. Prospective and retrospective data were available from 200 consecutive patients with gallstone pancreatitis at a public teaching hospital from 2003 through 2007. Charts were examined for persisting CBD stones on ERCP and/or intraoperative cholangiography during laparoscopic cholecystectomy. Patients with cholangitis (n = 18) were excluded. Nineteen of the remaining 182 (10%) patients had CBD stones. Mean hospital Day 2 bilirubin was 3.7 mg/dL for patients with CBD stones versus 1.4 mg/dL for those without (P < 0.0001). Seventeen patients (9%) had total bilirubin 4 or greater on hospital Day 2. Of these, eight (4%) had CBD stones (specificity 94%). Of the 165 patients with total bilirubin less than 4, 11 (7%) had CBD stones (P < 0.0001). In gallstone pancreatitis, a serum total bilirubin level 4 mg/dL or greater on hospital Day 2 predicts persisting CBD stones with enough specificity to serve as a practical guideline for ERCP while minimizing unnecessary procedures.

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