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Choledocholithiasis

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General Surgery

Pearls and Pitfalls

  • Choledocholithiasis may be identified in 5–10% of patients undergoing elective cholecystectomy.

  • The presence of choledocholithiasis correlates with patient age and is: 5%, 15%, and 35% in patients <60, 60–79, and >80 years of age, respectively.

  • Common duct stones can be classified into two types: primary and secondary. Primary stones form de novo in the common duct as a result of biliary infection or stasis. Secondary stones are identical in composition to gallbladder stones and presumably migrate from the gallbladder.

  • Clinical features of bile duct stones range from an incidental finding discovered during cholecystectomy to acute suppurative cholangitis.

  • An increased serum alkaline phosphatase activity, jaundice, and a dilated common bile duct are characteristic signs of common duct stones, but are not specific.

  • Magnetic resonance cholangiopancreatography (MRCP) is an effective, noninvasive method for detecting choledocholithiasis when suspected.

  • Endoscopic...

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Selected Readings

  • Haws RH, Sherman S (2001) Choledocholithiasis. In: Haubrich WS, Schaffner F, Berk JE (eds), Bockus Gastroenterology, Chapter 142, 5th edn. vol. 3. W.B. Saunders, Philadelphia, pp. 2745–2789

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  • Joyce WP, Keane R, Burke GJ, et al. (1991) Identification of bile duct stones in patients undergoing laparoscopic cholecystectomy. Br J Surg 78:1174–1176

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  • Kats J, Kraai M, Dijkstra AJ, et al. (2003) Magnetic resonance cholangiopancreaticography as a diagnostic tool for common bile duct stones: a comparison with ERCP and clinical follow-up. Dig Surg 20:32–37

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  • Lezoche E, Paganini AM (2000) Technical considerations and laparoscopic bile duct exploration: transcystic and choledochotomy. Semin Laparosc Surg 7:262–278

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  • Martin DJ, Vernon DR, Toouli J (2006) Surgical versus endoscopic treatment of bile duct stones. Cochrane Database Syst Rev 19:CD003327

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  • NIH state-of-the-science statement on endoscopic retrograde cholangiopancreatography (ERCP) for diagnosis and therapy. NIH Consens State Sci Statements 19:1–26

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  • Petelin JB (2003) Laparoscopic common bile duct exploration. Surg Endosc 17:1705–1715

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  • Tokumura H, Umezawa A, Cao H, et al. (2002) Laparoscopic management of common bile duct stones: transcystic approach and choledochotomy. J Hepatobiliary Pancreat Surg 9:206–212

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Author information

Authors and Affiliations

  1. Department of Surgery, Kyorin University, 6-20-2 Shinkawa, 181-8611, Mitaka, Tokyo, Japan

    Toshiyuki Mori, Yutaka Suzuki, Masanori Sugiyama & Yutaka Atomi

Authors
  1. Toshiyuki Mori
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  2. Yutaka Suzuki
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  3. Masanori Sugiyama
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  4. Yutaka Atomi
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Editor information

Editors and Affiliations

  1. Department of Surgery, Deputy Director, Comprehensive Cancer Center University of Alabama School of Medicine, Birmingham, AL, USA

    Kirby I. Bland MD (Fay Fletcher Kerner Professor and Chairman) (Fay Fletcher Kerner Professor and Chairman)

  2. Department of General and Visceral Surgery, University of Heidelberg, Heidelberg, Germany

    Markus W. Büchler MD (Professor of Surgery and Chairman) (Professor of Surgery and Chairman)

  3. Department of Surgery, University Hospital, Santiago, Chile

    Attila Csendes MD, FACS (Hon) (Professor of Surgery and Chairman) (Professor of Surgery and Chairman)

  4. James C. Mason Professor of Surgery Department of Surgery, Mayo Clinic College of Medicine, Rochester, MN, USA

    Michael G. Sarr MD

  5. Department of Clinical and Surgical Sciences, The University of Edinburgh Royal Infirmary of Edinburgh, Edinburgh, UK

    O. James Garden MBChB, MD, FRCS (Ed), FRCP (Ed), FRACS (Hon) (Regius Professor of Clinical Surgery) (Regius Professor of Clinical Surgery)

  6. Department of Surgery, The University of Hong Kong Queen Mary Hospital, Hong Kong, China

    John Wong BSc (Med (Syd)), MBBS (Syd), PhD (Syd), MD (Hon (Syd)), FRACS, FRCS (Edin), FRCS (Glasg), FACS (Hon) (Chair Professor) (Chair Professor)

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© 2009 Springer Science+Business Media, LLC

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Mori, T., Suzuki, Y., Sugiyama, M., Atomi, Y. (2009). Choledocholithiasis. In: Bland, K.I., Büchler, M.W., Csendes, A., Sarr, M.G., Garden, O.J., Wong, J. (eds) General Surgery. Springer, London. https://doi.org/10.1007/978-1-84628-833-3_106

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  • DOI: https://doi.org/10.1007/978-1-84628-833-3_106

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84628-832-6

  • Online ISBN: 978-1-84628-833-3

  • eBook Packages: MedicineReference Module Medicine

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