Diagnostic Flow Charts for Biliary Lithiasis

  • Emilie Lermite
  • Patrick Pessaux


Gallstones remain asymptomatic in nearly 80% of cases [1]. The clinical features of gallbladder stone disease include biliary colic and acute cholecystitis. Biliary colic is caused by impaction of the stone in the cystic duct with distension of the gallbladder and activation of visceral sensory neurons [2]. The pain typically arises in the right upper quadrant of the abdomen or epigastrium, rapidly increases in intensity and then plateaus, lasts for 30 min to 6 h, and occasionally radiates to the right subscapular area. Associated symptoms including nausea and vomiting are common.


Bile Duct Acute Cholecystitis Common Bile Duct Stone Bile Duct Stone Compute Tomogra 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gibney EJ (1990) Asymptomatic gallstones. Br J Surg 77:368–372PubMedCrossRefGoogle Scholar
  2. 2.
    Diehl AK, Sugarek NJ, Todd KH (1990) Clinical evaluation for gallstone disease; usefulness of symptoms and signs in diagnosis. Am J Med 89:29–33PubMedCrossRefGoogle Scholar
  3. 3.
    Friedman GD (1993) Natural history of asymptomatic and symptomatic gallstones. Am J Surg 165:399–404PubMedCrossRefGoogle Scholar
  4. 4.
    Leopold GR, Amberg J, Gosink BB, Mittlestaedt C (1976) Gray scale ultrasonic cholecystography: a comparison with conventional radiographic techniques. Radiology 121:445–448PubMedGoogle Scholar
  5. 5.
    Tranter SE, Thompson MH (2003) Spontaneous passage of bile duct stones: frequency of occurrence and relation to clinical presentation. Ann R Coll Surg Engl 85:174–177PubMedCrossRefGoogle Scholar
  6. 6.
    Scobie BA, Summerskill WH (1965) Hepatic cirrhosis secondary to obstruction of the biliary system. Am J Dig Dis 10:135–146PubMedCrossRefGoogle Scholar
  7. 7.
    Anciaux ML, Pelletier G, Attali P et al (1986) Prospective study of clinical and biochemical features of symptomatic choledocolithiasis. Dig Dis Sci 31:449–453PubMedCrossRefGoogle Scholar
  8. 8.
    Peng WK, Sheikh Z, Paterson-Brown S, Nixon SJ (2005), Role of liver function tests in predicting common bile duct stones in acute calculous cholecystitis. Br J Surg 92:1241–1247PubMedCrossRefGoogle Scholar
  9. 9.
    Stott MA, Farrands PA, Guyer PB et al (1991) Ultrasound of the common bile duct in patients undergoing cholecystectomy. J Clin Ultrasound 19:73–76PubMedCrossRefGoogle Scholar
  10. 10.
    Sugiyama M, Atomi Y (1997) Endoscopic ultrasonography for diagnosing choledocolithiasis: a prospective comparative study with ultrasonography and computed tomography. Gastrointest Endosc 45:143–146PubMedCrossRefGoogle Scholar
  11. 11.
    Gross BH, Harter LP, Gore RM et al (1983) Ultrasonic evaluation of common bile duct stones: a prospective comparison with endoscopic retrograde cholangio pancreatography. Radiology 146:471–474PubMedGoogle Scholar
  12. 12.
    Neitlich JD, Topozian M, Smith RC et al (1997) Detection of choledocolithiasis: comparison of unenhanced helicoidal CT and endoscopic retrograde cholangio pancreatography. Radiology 203:753–757PubMedGoogle Scholar
  13. 13.
    Polkowski M, Palucki J, Regula J et al (1999) Helicoidal computed tomographic cholangiography versus endosonography for suspected bile duct stones: a prospective blinded study in non-jaundiced patients. Gut 45:744–749PubMedCrossRefGoogle Scholar
  14. 14.
    Lightdale CJ (1997) Indications, contraindications, and complications of endoscopic ultrasonography. Gastrointest Endosc 43:S15–19CrossRefGoogle Scholar
  15. 15.
    Norton SA, Alderson D (1997) Prospective comparison of endoscopic ultrasonography and endoscopic retrograde cholangiopancreatography in the detection of bile duct stones. Br J Surg 84:1366–1369PubMedCrossRefGoogle Scholar
  16. 16.
    Frey CF, Burbige EJ, Meinke WB et al (1982) Endoscopic retrograde cholangiopancreatography. A J Surg 144:109–114.CrossRefGoogle Scholar
  17. 17.
    Ong TZ, Khor JL Selamat DS et al (2005) Complications of endoscopic retrograde cholangiography in the post-MRCP era: a tertiary center experience. World J Gastroenterol 11:5209–5212PubMedGoogle Scholar
  18. 18.
    Rhodes M, Sussman L, Cohen L, Lewis MP (1998) Randomised trial of laparoscopic exploration of common bile duct versus postoperative endoscopic retrograde cholangiography for common bile duct stones. Lancet 351:159–161PubMedCrossRefGoogle Scholar
  19. 19.
    Hallal AH, Amortequi JD, Jeroukhimov IM (2005) Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis. J Am Coll Surg 200:869–875PubMedCrossRefGoogle Scholar
  20. 20.
    NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. NIH Consens State Sci Statements 2002; 19:1–26Google Scholar
  21. 21.
    Griniatsos J, Karvounis E, Isla AM (2005) Limitations of fluoroscopic intraoperative cholangiography in cases suggestive of choledocholithiasis. J Laparoendosc Adv Surg Tech A 15:312–317PubMedCrossRefGoogle Scholar
  22. 22.
    Valls C, Guma A, Puig I et al (2000) Intrahepatic peripheral cholangiocarcinoma: CT evaluation. Abdom Imaging 25:490–496PubMedCrossRefGoogle Scholar
  23. 23.
    Nakayama F, Koga A (1984) Hepatolithiasis: present status. World J Surg 8:9–14PubMedCrossRefGoogle Scholar
  24. 24.
    Ohto M, Kimura K, Tsuchiva Y et al (1984) Diagnosis of hepatolithiasis. Prog Clin Biol Res 152:129–148PubMedGoogle Scholar
  25. 25.
    Park DH, Kim MH, Lee SS et al (2004) Accuracy of magnetic resonance cholangiopancreatography for locating hepatolithiasis and detecting accompanying biliary stricture. Endoscopy 36:987–992PubMedCrossRefGoogle Scholar
  26. 26.
    Fulcher AS, Turner MA, Capps GW et al (1998) Half-Fourier RARE MR cholangiopancreatography: experience in 300 subjects. Radiology 207:21–32PubMedGoogle Scholar
  27. 27.
    Su HC, Wei HC, Liu QX, Li YB (1991) Treatment of bilateral intrahepatic stones with high duct strictures through selective central hepatic resection. Surgery 110:8–12PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Emilie Lermite
    • 1
  • Patrick Pessaux
    • 2
  1. 1.Department of Digestive SurgeryCHU AngersAngersFrance
  2. 2.Department of Hepatic Surgery and TransplantationHospital of HautepierreStrasbourgFrance

Personalised recommendations