Choledocholithiasis

Epidemiology

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Etiology

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Pathophysiology

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Clinical features

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Diagnostics

Endoscopic retrograde cholangiopancreatography (ERCP)

• Indication: preferred confirmatory imaging for patients with a high likelihood of choledocholithiasis
  • Diagnostic and therapeutic
• Complications
  • Post-ERCP pancreatitis: pancreatic inflammation secondary to ERCP c
    • Incidence: ∼ 3.5% 
    • Diagnostic criteria (all of the following)
      • New or worsened postinterventional abdominal pain
      • New or prolonged hospitalization (at least 2 days)
      • Serum amylase > 3 times the upper limit, measured > 24 hours after the intervention
    • Prevention: Consider indomethacin

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Treatment

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Complications

• Gallstones ileus: mechanical bowel obstruction due to obstructive Gallstones
  • Pathophysiology: gallbladder perforation or Mirizzi syndrome → biliary-enteric fistula formation (most commonly cholecystoenteric fistula) between the inflamed gallbladder and bowel → Gallstones passing down into bowel lumen
  • Sites of obstruction: terminal ileum, at ileocecal valve (most common)
  • Symptoms: distal bowel obstruction: features of mechanical bowel obstruction (abdominal pain and distention, nausea, vomiting)
  • Diagnosis is based on the Rigler triad: imaging findings of small bowel obstruction, Gallstones (most commonly in iliac fossa), and pneumobilia.
    • Air can move up toward the biliary ducts through a cholecystoenteric fistula.