Bile Duct Stones
Bile duct stones are the conditions in which one experiences gallstones in the bile duct. Also known as choledocholithiasis, bile duct stones often originate in the gallbladder and move into the bile duct. Primary ductal stone is another form of choledocholithiasis where stones form primarily in the bile duct due to infection or slow flowing of the bile into the duodenum.
Not all the bile duct stones can be passed out due to the narrower structure of the distal bile duct and narrowing of the Sphincter of Oddi. When a stone is jammed at the bile duct, the bile flow is obstructed, and this will lead to jaundice and cholangitis – a medical emergency.
Symptoms:
Bile duct stones free floating in the bile duct do not exhibit any symptoms unless they cause a blockage, obstruction or infection. Some common symptoms often observed can include:
- Abdominal pain in the upper/middle regions
- Fever
- Jaundice
- Loss of appetite
- Nausea
- Vomiting
Treatment:
Blood test will be needed to look for the presence of inflammation and obstructive jaundice. CT and MRI scans are common investigations to identify the bile duct stone.
Smaller stones can be removed easily with ERCP.
However, patients with obstructive jaundice and cholangitis will urgently require treatment as it will lead to sepsis if treatment is delayed. The proper treatment includes iv antibiotics and ERCP with stenting to bypass the obstructions. If an ERCP is not possible, percutaneous transhepatic biliary drainage has to be offered. Sometimes a repeat ERCP is needed after the infection is controlled to clear the bile duct stone.
When the bile duct stones are cleared and the patient’s sepsis is controlled, laparoscopic cholecystectomy will then be offered to the patient; this is to prevent the recurrence of cholangitis.
Frequently a big bile duct stone cannot be removed successfully with ERCP; therefore, the patient may benefit from laparoscopic common bile duct exploration, i.e. surgical removal of bile duct stone. Laparoscopic cholecystectomy to remove the gallbladder will be done simultaneously to prevent the condition’s recurrence in the future.
