Clinical Pictures of Common Bile Duct Stones

  • Jürgen Treckmann
  • Christoph E. Broelsch
  • Andreas Paul


The clinical presentations of common bile duct stones (CBDS) can vary widely: patients with large impacted stones may present as asymptomatic, while other patients may be severely ill with cholangiogenic sepsis or necrotizing biliary pancreatitis due to small stones in the papilla of Vater. Sometimes clinical symptoms of CBDS are residual signs of spontaneous passage with complete clearance of the CBD and without the need for further therapy. In these times of laparoscopic cholecystectomy without routinely performed intraoperative cholangiography, preoperative diagnosis is more important especially because therapeutic splitting with preoperative endoscopic retrograde cholangiopancreatography (ERCP) and clearance of the CBD followed by laparoscopic cholecystectomy is the most frequently applied technique, at least in surveys in Scotland (96.2%) and Germany (94.2%) [1, 2].


Laparoscopic Cholecystectomy Common Bile Duct Stone Biliary Pancreatitis Gallbladder Stone Spontaneous Passage 
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.
    Hamouda A, Khan M, Mahmud S et al (2004) Management trends for suspected ductal stones in Scotland (abstract). 9th World Congress of Endoscopic Surgery, CancunGoogle Scholar
  2. 2.
    Ludwig K, Lorenz D, Koeckerling F (2002) Surgical strategies in the laparoscopic therapy of cholecystolithiasis and common duct stones. ANZ J Surg 72:547–552PubMedCrossRefGoogle Scholar
  3. 3.
    Pring CM, Skelding-Millar L, Goodall RJ (2005) Expectant treatment or cholecystectomy after endoscopic retrograde cholangiopancreatography for choledocholithiasis in patients over 80 years old? Surg Endosc 19:357–360PubMedCrossRefGoogle Scholar
  4. 4.
    Vrochides DV, Sorrells DL Jr, Kurkchubasche AG et al (2005) Is there a role for routine preoperative endoscopic retrograde cholangiopancreatography for suspected choledocholithiasis in children? Arch Surg 140:359–361PubMedCrossRefGoogle Scholar
  5. 5.
    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
  6. 6.
    Sgourakis G, Dedemadi G, Stamatelopoulos A et al (2005) Predictors of common bile duct lithiasis in laparoscopic era. World J Gastroenterol 11:3267–3272PubMedGoogle Scholar
  7. 7.
    Abboud PA, Malet PF, Berlin JA et al (1996) Predictors of common bile duct stones prior to cholecystectomy: a metaanalysis. Gastrointest Endosc 44:450–455PubMedCrossRefGoogle Scholar
  8. 8.
    Freitas ML, Bell RL, Duffy AJ (2006) Choledocholithiasis: evolving standards for diagnosis and management. World J Gastroenterol 12:3162–3167PubMedGoogle Scholar
  9. 9.
    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
  10. 10.
    Stone HH, Fabian TC, Dunlop WE (1981) Gallstone pancreatitis: biliary tract pathology in relation to time of operation. Ann Surg 194:305–310PubMedCrossRefGoogle Scholar
  11. 11.
    Neoptolemus JP, London NJ, Bailey IA et al (1988) Controlled trial of urgent endoscopic retrograde cholangiopancreaticography and sphincterotomy versus conservative management for acute pancreatitis due to gallst ones. Lancet 2:979–983CrossRefGoogle Scholar
  12. 12.
    Acevedo C, Mandirola F, Teixeira M (2006) Delayed surgery in impacted common bile duct calculi: lower percentage of biliary tract interventions. Cir Esp 79:361–364PubMedCrossRefGoogle Scholar
  13. 13.
    Rickes S, Treiber G, Mänkemäller K et al (2006) Impact of the operator’s experience on value of high-resolution transabdominal ultrasound in the diagnosis of choledocholithiasis: a prospective comparison using endoscopic retrograde cholangiography as the gold standard. Scand J Gastroenterol 41:838–843PubMedCrossRefGoogle Scholar
  14. 14.
    Scientific Committee of the European Association for Endoscopic Surgery (E.A.E.S.) (1998) Diagnosis and treatment of common bile duct stones (CBDS). Results of a consensus development conference. Surg Endosc 12:856–864CrossRefGoogle Scholar
  15. 15.
    Metcalfe MS, Ong T, Bruening MH et al (2004) Is laparoscopic intraoperative cholangiogram a matter of routine? Am J Surg 187:475–481PubMedCrossRefGoogle Scholar
  16. 16.
    Caddy GR, Kirby J, Kirk SJ et al (2005) Natural history of asymptomatic bile duct stones at time of cholecystectomy. Ulster Med J 74:108–112PubMedGoogle Scholar
  17. 17.
    Boerma D, Rauws EA, Keulemans YC et al (2002) Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial. Lancet 360:761–765PubMedCrossRefGoogle Scholar
  18. 18.
    Schreurs WH, Vles WJ, Stuifbergen WH, Oostvogel HJ (2004) Endoscopic management of common bile duct stones leaving the gallbladder in situ. A cohort study with long-term follow-up. Dig Surg 21:60–64PubMedCrossRefGoogle Scholar
  19. 19.
    Lee JK, Ryu JK, Park JK et al (2006) Risk factors of acute cholecystitis after endoscopic common bile duct stone removal. World J Gastroenterol 12(6):956–960PubMedGoogle Scholar
  20. 20.
    Collins C, Maguire D, Ireland A et al (2004) A prospective study of common bile duct calculi in patients undergoing laparoscopic cholecystectomy: natural history of choledocholithiasis revisited. Ann Surg 239:28–33PubMedCrossRefGoogle Scholar
  21. 21.
    Pring CM, Skelding-Millar L, Goodall RJ (2005) Expectant treatment or cholecystectomy after endoscopic retrogradecholangiopancreatography for choledocholithiasis in patients over 80 years old? Surg Endosc 19:357–360PubMedCrossRefGoogle Scholar
  22. 22.
    Uhl W, Warshaw A, Imrie C et al (2002) IAP Guidelines for the surgical treatment of acute pancreatitis. Pancreatology 2:565–573PubMedCrossRefGoogle Scholar
  23. 23.
    Eimiller A, Born P, Berg P et al (1988) Mikrolithen als Verursacher der akuten Pankreatitis. Z Gastroenterol 26:446Google Scholar
  24. 24.
    Appelroos S, Borgström A (1999) Incidence, aetiology and mortality rate of acute pancreatitis over 10 years in defined urban population in Sweden. Br J Surg 86:465–470CrossRefGoogle Scholar
  25. 25.
    Secknus R, Mössner J (2000) Incidenz-und Prävalenzveränderungen der akuten und chronischen Pankreatitis in Deutschland. Chirurg 71:249–252PubMedGoogle Scholar
  26. 26.
    Schietroma M, Carlei F, Lezoche E et al (2001) Acute biliary pancreatitis: staging and management. Hepatogastroenterology 48:988–993PubMedGoogle Scholar
  27. 27.
    Terblanche J, Allison HF, Northover JMA (1983) An ischemic basis for ischemic biliary strictures. Surgery 94:52–57PubMedGoogle Scholar
  28. 28.
    Mercado MA, Chan C, Orozco H (2002) To stent or not to stent bilioenteric anastomosis after iatrogenic injury. A dilemma not answered? Arch Surg 137:60–63PubMedCrossRefGoogle Scholar
  29. 29.
    Ochi Y, Mukawa K, Kiyosawa K, Akamatsu T (1999) Comparing the treatment outcomes of endoscopic papillary dilation and endoscopic sphincterotomy for removal of bile duct stones. J Gastroenterol Hepatol 14:90–96PubMedCrossRefGoogle Scholar
  30. 30.
    Tsujino T, Isayama H, Komatsu Y et al (2005) Risk factors for pancreatitis in patients with common bile duct stones managed by endoscopic papillary balloon dilation. Am J Gastroenterol 100:38–42PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Jürgen Treckmann
    • 1
  • Christoph E. Broelsch
    • 1
  • Andreas Paul
    • 1
  1. 1.Clinic for General Visceral and Transplantation SurgeryUniversity Hospital of EssenEssenGermany

Personalised recommendations