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Surgical Diseases of the Pancreas and Biliary Tree pp 65–120Cite as

Gallbladder Stones and Common Bile Duct Stones

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Abstract

The prevalence of gallstone disease in Western communities is 10–15%. However, many people with gallstone disease (up to 80%) remain asymptomatic throughout their life and do not require surgical intervention. Presentation of symptomatic gallstones is very common with over 57,000 cholecystectomies performed annually in the United Kingdom. Acute presentations due to gallstone disease are the second most frequent cause of an acute surgical abdomen.

The most frequent presentation is with episodes of biliary pain (colic). These are episodes of upper abdominal pain lasting 30 min to 8 h and then resolving. This clinical problem is routinely managed with an elective laparoscopic cholecystectomy (LC). Complications of gallbladder stones include acute cholecystitis and its various sequelae including; mucocoele, gangrenous cholecystitis, emphysematous cholecystitis, perforation and chronic cholecystitis. Rare complications of gallbladder stones include Mirizzi syndrome, gallstone ileus and cholecysto-enteric fistula. Gallbladder stones may migrate into the common bile duct (CBD) (secondary), or stones may occur de novo in the common bile duct (primary). Common bile duct (CBD) stones may present with biliary pain, jaundice, cholangitis or acute pancreatitis.

Symptomatic gallstones are normally managed with a LC. LC is a safe, low-risk operation. Immediate complications of LC include bile leak, CBD injury and bleeding. Early detection of bile leak or CBD injury is essential to allow for early rescue. Delayed diagnosis and treatment of these complications leads to much poorer outcomes. Late complications include retained CBD stones, biliary stricture and port-site hernia.

CBD stones found on routine operative cholangiography may be managed at LC with transcystic removal or laparoscopic choledochotomy and stone extraction or managed post-operatively with an endscopic retrograde cholangio-pancreatography (ERCP) and sphincterotomy (ES), preferably facilitated by the insertion of a transcystic stent at the time of LC. Patients presenting with CBD stones (primary or retained secondary) after cholecystectomy require an ERCP and ES for the treatment of these stones. Complications of ERCP and ES for the treatment of CBD stones include acute pancreatitis, cholangitis, haemorrhage and duodenal perforation. Early detection of a duodenal perforation, which mimics acute pancreatitis, is essential to allow for early rescue and avoidance of delayed diagnosis and treatment. Early diagnosis is achieved with an urgent CT scan in any patient with post-ERCP abdominal pain.

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Authors and Affiliations

  1. Department of Surgery, University of Sydney, Nepean Clinical School, Nepean Hospital, Penrith, NSW, Australia

    Michael R. Cox MB, MS, FRACS

  2. Department of Surgery, Nepean Blue Mountains Local Health District, Penrith, NSW, Australia

    Michael R. Cox MB, MS, FRACS

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  1. Michael R. Cox MB, MS, FRACS
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  1. Gastrointestinal Surgery, Medanta – The Medicity, Gurgaon, Haryana, India

    Savio George Barreto

  2. Professor of Surgery, HBP/Upper GI Surgeon, Auckland City Hospital, University of Auckland, Auckland, New Zealand

    John A. Windsor

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Cox, M.R. (2018). Gallbladder Stones and Common Bile Duct Stones. In: Barreto, S., Windsor, J. (eds) Surgical Diseases of the Pancreas and Biliary Tree. Springer, Singapore. https://doi.org/10.1007/978-981-10-8755-4_4

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