There are two types of stones in the common bile duct. one is primary CBD stones and other is secondary stones. Primary common bile duct stone form primarily in the CBD (Common bile duct) only whereas when the stone in the gallbladder slips into the common bile duct these are called as secondary common bile duct stones.
Symptoms of CBD stones
Common bile duct stones may be asymptomatic but when symptomatic the most common symptom is pain abdomen which may be mild to moderate. Pain is usually located on the right upper abdomen. When Common bile duct stone causes complete obstruction of CBD patient will have jaundice. The typical feature of obstructive jaundice is pale colored stool and itching due to deposition of bile salts. If obstructed bile gets infected patients may have a fever. The triad of fever/jaundice/pain abdomen suggest cholangitis and require immediate intervention.
Diagnosis of CBD stones
USG abdomen can show large common bile duct stones but it can miss small one. For better delineating small stones, MRI/MRCP abdomen is done. Endoscopic ultrasound is available for even small stones missed on MRI. Now the recommendations are EUS guided ERCP means as small stones may pass spontaneously before doing ERCP EUS should be done and if it shows stones then the only ERCP should be done
Treatment of CBD stones
The primary treatment of Common bile duct stone is Endoscopic stone removal (ERCP stone removal). Chances of ERC stone removal is less if there are multiple and large stones. Treatment of failed ERC is surgical removal of CBD stones.
The surgical options are CBD exploration and CBD stone removal with
- primary closure of CBD
- T-tube drainage
- Choledocho-duodenostomy
- Hepatico-jejunostomy