Preoperative clinical predictors of choledocholithiasis compared to radiological imaging

Bora Koc, MD

Department of Surgery, Okmeydani Training and Research Hospital

Background: Common bile duct (CBD) stones can cause serious morbidity or mortality, and evidence for them should be sought in all patients with symptomatic gallstones undergoing cholecystectomy. ERCP and laparoscopic common bile duct exploration (LCBDE) are safe and efficient methods that are recently used for the treatment of bile duct stones.

Material and Methods: A total of 392 consecutive patients which were treated for CBD stones from 2007 June to 2011 June were taken into analysis retrospectively in Okmeydani Training and Research Hospital. Previous and current clinical history and radiological indices were used to assess the need for preoperative evaluation of the CBD.

Results: MRC or US evaluation was normal in 36 (%9.2) patients, which had a history of suspected choledocholithiasis and cholangiography were performed. CBD stones were detected in 13 (%36.1) patients with cholangiography and LCBDE was performed. There was no evidence of choledocholithiasis diagnosed by US in 27 patients. 13 patients had a history of dark urine whose US was normal in preoperative evaluation and CBD stones were found in 8 of these patients.

Conclusion: Clinical history consist of fever, right upper quadrant pain, itching and dark urine have specificities for CBD stone suspicious. When these examinations were taken in combination, however, they were 100% specific in excluding choledocholithiasis.

Session: Poster Presentation

Program Number: P340

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