Bile duct lithiasis

 

Definition

Bile duct lithiasis is defined by the presence of biliary stones in the gallbladder and the intrahepatic bile ducts, or in the common bile duct outside the liver.

The cause of bile duct lithiasis in children is only known in 30% of cases. Sometimes it is caused by excessive cholesterol in the blood. Certain chronic diseases (such as haemolytic blood diseases), long-term parenteral nutrition, and extensive resections of the small intestine may favour its development.

 

Symptoms

Bile duct lithiasis is often asymptomatic and is only discovered by chance during an abdominal ultrasound scan for another reason. However, it can cause attacks of abdominal pain known as “biliary colic”. The two major complications are acute cholecystitis and the migration of the stones into the common bile duct with the risk of biliary retention (associated with jaundice) or pancreatitis.

 

Diagnosis

An abdominal ultrasound scan is used to visualise bile duct lithiasis. Ultrasound imaging may be supplemented by magnetic resonance cholangio-pancreatography (MRCP). A blood test is performed in addition to the imaging procedures to find the reason for the formation of stones and to monitor any irritation of the liver or pancreas.

 

Treatment

Asymptomatic bile duct lithiasis with no known aetiology is simply monitored because the stones may disappear spontaneously. Bile duct lithiasis that is symptomatic or secondary to chronic haemolysis requires surgical excision of the gallbladder, preferably by coelioscopy (laparoscopy). Cholangiography (visualisation of the bile ducts) is often performed during the intervention to locate and remove any stones lodged in the bile duct.
In infants, percutaneous cholangiography often makes bile duct irrigation possible to remove the obstruction.

 

Prof. Barbara Wildhaber
2014