Common Bile Duct (CBD) StonesIf a small stone passes out of the gallbladder, it may lodge in the common bile duct causing partial or complete obstruction of that structure. Clinically, this presents as jaundice with yellow discoloration of the skin and eyes to a varying degree. The presence of fever implies cholangitis which is extremely serious.
In some cases, a stone may pass through the common duct and obstruct the outlet of the pancreatic duct leading to pancreatitis, inflammation of the pancreas.
Ductal stones should always be cleared.
Management of CBD Stones
I. Laparoscopic (keyhole) clearance of CBD Stones
This is an advanced laparoscopic technique employed in fit patients with mild cholangitis in the presence of gallbladder and CBD stones. This technique has the distinct advantage of treating both conditions during the same setting, avoiding the potential serious risks of ERCP and preserving the biliary valve mechanism, the disruption of which especially in the young patients predisposes to cancer within the bile duct.
These are operative photograph demonstrating the use of ultra-thin scope (choledochoscope) and the removal of the stone from the bile duct laparoscopically.
II. Endoscopic Clearance of CBD stones
This should be utilised in elderly patients or in the presence of severe cholangitis.
This diagram is showing the entrapment of CBD stone within an endoscopic basket prior to its removal.