RETAINED STONES IN THE COMMON BILE DUCT

Abstract

Retained stones in the common bile duct is not uncommon

:t complic:: tion of bihary surgery . The re;d incidence of retained :;tones '1

is unkno\vn but reported Ligures ranges from 5 to 20 percent . The

following ti.nclings should akrl the surgeon to the possibility of -

cholcclocholothi:: sis at the time of cholec•vstcctomv•

:. ::1 dilated

common bile cystic duct {occasionally a stone may be palpated unexpectedly) , dilated cystic duct ; and an abnormal peroperative cholangiogr::m (i.e. a filling defect, non filling of part ofbiliary tr:: ct on no fl.O\v of contrast into the duodenum despite intravenous injection of an antispasmodics such as hyocin or glucagon . Intraoperative cholangiogrZ phy should remain as the method of choice , especiZ lly for the display of the anatomic anomalies before fmiher dissection initaited this is important for the indicZltion or duct ' exploration chlcclochoscopy is probably the best method for

exploring the duct and csuri.ng the complete clearness of stones . Common bile duct stones usu 1Uy come from the gallbladder although primary common bile duct stones do Jiom . Small calculi probably leave the common bile duct and enter the duodenum without causing symptoms but others remain and will eventually cause symptoms in 25 - 50 percent of patients by either presence in the common bile duct or as they pass tlu•ough the ampulla . The most common symptoms of common bileduct stones is pain which is often percievccl as a boring sensation and as more central , in the epigastrium than as a right sided pain , possibly with posterior radiation . Jaundice atler biliary surgery must be evaluated and differentiated fi•om other case:> of jaundice . Tilis allows the early interference vvith the cause especially if there is common bile duct obst1uction . TI1ere is a variety of investigations for dicovering of retained stones in the common bile duct and their effects. Laboratmy tests are important for confirmation of jaundice and differentiation of '' obst1uctive type from other types of jaundice . Dilation