Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis

Introduction: Standard recommendations for patients recovering from an episode of biliary pancreatitis include cholecystectomy with intra operative cholangiogram or ERCP during the same hospital admission as it is believed that the instigating factor is the passage of stones through the common bile duct. As ERCP is not widely available and expensive, cholecystectomy with IOC is routinely performed to rule out choledocholithiasis. However detection of common bile duct stones is challenging. Whether these patients undergoing cholecystectomy require direct common bile duct evaluation is controversial. Objective of the study was to see the presence of common bile duct stones in patients with resolving acute mild biliary pancreatitis. Methods: Patients admitted in the surgical ward in Patan Hospital and Bir Hospital with the diagnosis of mild acute biliary pancreatitis who underwent cholecystectomy with intra-operative cholangiography from August 2010 to July 2012 were studied. The outcome of cholangiogram was analyzed together with findings of common bile duct exploration. Results: A total of 52 patients with acute mild biliary pancreatitis were operated during this period. The common bile duct stone was found in 1.9%. Out of four patients with abnormal cholangiogram, only one patient (25%) had stone on exploration, rest of the three cases (75%) had negative exploration.Conclusion: The presence of common bile duct stone in case of mild acute biliary pancreatitis undergoing cholecystectomy is very low (1.96%), and thus policy of selective IOC should be applied for cases with mild biliary pancreatitis.Journal of Society of Surgeons of Nepal Vol.17(1) 2014: 11-15

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Presence of choledocholithiasis in patients undergoing cholecystectomy for mild biliary pancreatitis

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v15i4.30711 ◽

2016 ◽

Vol 15 (4) ◽

pp. 517-521

Author(s):

Sumita Pradhan ◽

JN Shah

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Common Bile Duct Stone ◽

Bile Duct Stone ◽

Medical Science ◽

Common Bile Duct Stones ◽

Biliary Pancreatitis ◽

Bile Duct Stones ◽

Acute Biliary Pancreatitis ◽

The Common

Background: Standard recommendations for patients recovering from an episode of biliary pancreatitis include cholecystectomy with intra operative cholangiogram or ERCP during the same hospital admission as it is believed that the instigating factor is the passage of stones through the common bile duct. As ERCP is not widely available and expensive, cholecystectomy with IOC is routinely performed to rule out choledocholithiasis. However detection of common bile duct stones is challenging. Whether these patients undergoing cholecystectomy require direct common bile duct evaluation is controversial.Objectives: To see the presence of common bile duct stones in patients with resolving acute mild biliary pancreatitis.Materials and Methods: Patients admitted in the surgical ward in Patan and Bir hospital with the diagnosis of mild acute biliary pancreatitis that underwent cholecystectomy with intra operative cholangiography from August 2010 to July 2011 were studied. The outcome of cholangiogram was analyzed together with findings of Common bile duct exploration.Result and Conclusion: A total of 52 patients with acute mild biliary pancreatitis were operated during this period. The Common bile duct stone was found in 1.9%. Out of four patients with abnormal cholangiogram, only one patient (25%) had stone on exploration, rest of the three cases (75%) had negative exploration. The presence of common bile duct stone in case of mild acute biliary pancreatitis undergoing cholecystectomy is very low (1.96%), and thus policy of selective IOC should be applied for cases with mild biliary pancreatitis.Bangladesh Journal of Medical Science Vol.15(4) 2016 p.517-521

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Positive Intraoperative Cholangiography during Laparoscopic Cholecystectomy: Is Laparoscopic Common Bile Duct Exploration Necessary?

The American Surgeon ◽

10.1177/000313480507100911 ◽

2005 ◽

Vol 71 (9) ◽

pp. 750-753

Author(s):

Gabriel Akopian ◽

James Blitz ◽

Thomas Vander Laan

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Common Bile Duct ◽

Case Series ◽

Common Bile Duct Stones ◽

Common Bile Duct Exploration ◽

Bile Duct Stones ◽

Endoscopic Retrograde ◽

Technical Problems ◽

The Common

The treatment of choledocholithiasis discovered incidentally during laparoscopic cholecystectomy is not yet standardized. Options include laparoscopic common bile duct exploration (LCBDE), postoperative endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy (ERCP-ES), and no intervention. We undertook a review of our case series to determine whether LCBDE is obligatory and which LCBDE method is unsuccessful. During the 6-year study period, 91 patients with choledocholithiasis were identified. Fifty-six patients (62%) underwent LCBDE. Thirteen (23%) of these 56 patients subsequently required ERCP. Balloon sweeping of the common bile duct failed in 10 of 21 patients (48% failure) compared to any other combination of techniques with a failure rate of 1/33 (3%; P < 0.001). Two patients did not undergo complete duct exploration because of technical problems. Thirty-five patients (38%) did not undergo LCBDE. Nine of these patients (26%) did not have ERCP-ES. None of the patients who underwent postoperative ERCP-ES required additional procedures or surgery. LCBDE can successfully treat common bile duct stones, with minimal to no morbidity, but is not mandatory for safely treating choledocholithiasis. Additionally, advanced techniques for clearing the common bile duct are more successful. Surgeons should be proficient at performing these techniques.

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Does presence of common bile duct stones in patients with acute biliary pancreatitis affect the severity of illness or laboratory findings?

The Turkish Journal of Gastroenterology ◽

10.4318/tjg.2011.0242 ◽

2011 ◽

Vol 22 (5) ◽

pp. 517-522

Author(s):

Emrah ALPER ◽

Behlul BAYDAR ◽

Sezgin VATANSEVER ◽

Zafer BUYRAC ◽

Fatih ASLAN ◽

...

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Severity Of Illness ◽

Common Bile Duct Stones ◽

Biliary Pancreatitis ◽

Bile Duct Stones ◽

Laboratory Findings ◽

Acute Biliary Pancreatitis

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Giant common bile duct stone

Open Medicine ◽

10.2478/s11536-011-0102-5 ◽

2012 ◽

Vol 7 (1) ◽

pp. 59-62

Author(s):

Hyung Han ◽

Jin Lee ◽

Tae Song

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Common Bile Duct Stone ◽

Bile Duct Stone ◽

Acute Cholangitis ◽

Common Bile Duct Stones ◽

Normal Liver ◽

Liver Function Tests ◽

Bile Duct Stones ◽

Large Size

AbstractBile duct stones, which obstruct the common bile duct, potentially result in complications, such as acute cholangitis and pancreatitis. We present a case involving a patient with normal liver function tests from whom we removed a giant common bile duct stone measuring 7.5 centimeters × 4.0 centimeters × 4.0 centimeters. Postoperatively recurrent common bile duct stones were observed and removed with an endoscopic maneuver in the three-year follow-up period. Recurrent bile duct stones are frequently reported in the case of large size of stones or multiple stones. Surgical treatment may then be considered as a first-line treatment in cases of recurrent common bile duct stones. When an endoscopic or surgical approach is used for the treatment of giant common bile duct stones, careful observation is of the utmost importance and treatment innovations may be necessary.

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