When stones are found inside the common bile duct, the condition is called choledocholithiasis. Usually, these stones are the one which slipped from the gallbladder. Rarely stones form in the common bile duct itself. This may block the bile flow and cause jaundice, pain, and fever. Liver function tests will show abnormally elevated bilirubin and enzymes level. Obstruction of bile flow along with superadded infection can lead to a life-threatening infection called cholangitis. In this condition, the bacteria, as well as toxins from the biliary tree, enter into blood circulation. If the block has not been relieved promptly, the patient may go into septic shock and multi-organ failure.
Whether symptomatic or not, common bile duct stones should be removed. Subsequent removal of gallbladder along with stones also necessary to prevent further attacks.
An ERCP (endoscopic retrograde cholangiopancreatography) procedure is done to treat those with bile duct stones. This involves inserting a long tube with a camera at the end down the throat into the duodenum (first part of the small intestine). The bile duct is cannulated and its opening widened by cutting its sphincter muscle (sphincterotomy) and then the stones are removed. Plastic stent (tube) may be inserted to keep the drainage intact. The plastic stent should be removed at a later date.
If common bile duct stones cannot be cleared by the endoscopic method, surgery is done. This can be done open and laparoscopic (Keyhole) method and this can be combined with gallbladder removal surgery (Cholecystectomy).
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