Choledocholithiasis: Incorrect

Choledocholithiasis is the presence of stones within the common bile duct or hepatic duct. Overall, 10-15% of patients with cholelithiasis have choledocholithiasis and the risk increases with age. It is therefore very important not to assume a patient with stones in the gallbladder does not have stones in the bile ducts. A patient with choledocholithiasis may be asymptomatic, or may have any combination of the following: biliary colic, jaundice, cholangitis (infection within the bile ducts), or pancreatitis. Biliary colic from CBD obstruction cannot be distinguished from stones in the gallbladder. The clues to diagnosis are the following: A dilated common bile duct to 2-3 cm proximal to the obstruction (measured with ultrasound), increased fever or chills, a rising level of serum Bilirubin (usually in the range of 2-4 mg/dl), elevated WBC greater than 15K, increased SGOT and SGPT. Tenderness in the RUQ is usually less impressive than with acute cholecystitis although hepatic enlargement can occur due to obstruction of bile flow.

This patient does not appear to have choledocholithiasis. No gallstones were seen in her bile ducts and the CBD was not dilated beyond normal. In addition, all of her LFTs were normal except for a mild elevation in serum bilirubin that often occurs with acute cholecystitis. Her WBC count was not too elevated and her fever was moderate. Although the presence of stones in the bile ducts is less likely in this patient, the only way to completely rule it out is with a cholangiogram.

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