From the Guidelines
Choledocolithiasis typically presents with severe and colicky right upper quadrant or epigastric abdominal pain, jaundice, dark urine, and light-colored stools, and requires prompt medical attention to prevent complications such as cholangitis, pancreatitis, and liver damage. The symptoms of choledocolithiasis can be severe and debilitating, and if left untreated, can lead to significant morbidity and mortality 1. Patients often experience nausea and vomiting, fever, and chills, which can indicate an infection called cholangitis, a medical emergency that requires immediate attention. Some patients may also report pruritus (itching) due to bile salt accumulation in the skin.
Common Symptoms
- Severe and colicky right upper quadrant or epigastric abdominal pain
- Jaundice (yellowing of the skin and eyes)
- Dark urine and light-colored stools
- Nausea and vomiting
- Fever and chills
- Pruritus (itching)
Laboratory Findings
- Elevated liver enzymes, particularly alkaline phosphatase and gamma-glutamyl transferase
- Increased bilirubin levels According to the study published in the Journal of the American College of Radiology, choledocolithiasis is a potentially life-threatening condition that requires biliary decompression in nearly all cases, though initial medical management is indicated to stabilize hemodynamic status and treat local and systemic infection 1. The study also notes that even in the absence of symptoms, choledocholithiasis requires intervention because of the risk of developing obstructive jaundice, cholangitis, acute pancreatitis, and potentially secondary biliary cirrhosis. Prompt medical attention is necessary when symptoms of choledocolithiasis occur, and treatment should be guided by the most recent and highest quality evidence, such as the study by Fairchild et al 1.
From the Research
Symptoms of Choledocolithiasis
The symptoms of choledocolithiasis are primarily caused by biliary obstruction due to stones in the common bile duct. Some common symptoms include:
- Biliary obstruction
- Cholangitis
- Pancreatitis
Diagnosis and Treatment
Diagnosis of choledocolithiasis is typically made using advanced imaging techniques such as:
- Magnetic resonance cholangiopancreatography (MRCP)
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Endoscopic ultrasound (EUS)
Treatment options for choledocolithiasis include:
- ERCP with sphincterotomy 2
- Percutaneous techniques for removal of intrahepatic and extrahepatic bile duct stones 3
- Surgical interventions in patients with complicated cases 4
Complications
Choledocolithiasis can lead to serious complications such as:
- Cholangitis, a life-threatening condition that requires prompt treatment 5
- Pancreatitis, which can be caused by stones in the common bile duct 4
Diagnostic Accuracy
Studies have shown that MRCP and EUS have similar diagnostic accuracy for detecting choledocolithiasis 6. The choice of diagnostic technique may depend on the individual patient's situation and the availability of resources.