MANAGEMENT OF COMMON BILE DUCT STONES

Abstract

The presence of common bile duct stones is not an uncommon complication of biliary surgery . These stones may be primary stones (8-12o/o) which are formed in the duct system or secondary stones which are formed in the gall bladder and then pass into the ductal system via the cystic duct. The possibility of choledocholithiasis at the time of cholecystectomy should be considered if there is a dilated common bile duct, dilated cystic duct or palpable stone and abnormal preoperative cholangiogram i.e a filling defect .non filling of part of biliary tract or no flow of contrast into the duodenum despite intravenous injection of an antispasmodic such as hyocine or glucagon. Intraoperative cholangiography should remam as the method of choice especially for the display of stones as the anatomic anomalies before further dissection is initiated. Choledochoscopy is probably the best method for exploring the duct and ensuring the complete clearance of stones . Preoperative and post operative biliary endoscopy will greatly reduce the retained stones rate to acceptable levels . The most common symptom of CBD stones is pain which is often perceived as a boring and more central in the epigastrium than a right sided pain, possibly with posterior