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Treatment options for common bile duct stones

Division of Gastroenterology, Craigavon Area Hospital, 68 Lurgan Road, Portadown, Craigavon BT63 5QQ, Northern Ireland

Correspondence to:
Correspondence to:
Dr Ferguson;
hrferguson@doctors.net.uk

Submitted 30 September 2002
Accepted 17 December 2002

Keywords: lithotripsy; bile duct stones

The first 100% of the full text of this article appears below.

An 83 year old woman presented with a two week history of right upper quadrant pain, pale stools, dark urine, and itch. In the previous five years there had been two episodes of similar symptoms, ultrasound scan showing multiple gall bladder calculi. Past history included hypertension, type 2 diabetes mellitus, and obesity.

On examination she was not clinically icteric, apyrexic, but mildly tender in the right upper quadrant. Liver enzymes were obstructive, bilirubin 31 µmol/l (3–20 µmol/l), alkaline phosphatase 842 U/l (100–280 U/l), -glutamyltranspeptidase 778 U/l (5–50 U/l).

On ultrasound scan there were gallbladder stones and a dilated common bile duct of 11 mm. Endoscopic retrograde cholangiopancreatography revealed a large single calculus in the dilated common bile duct, unable to be extracted after spincterotomy.

QUESTIONS

1. What are the treatment options for this patient?
   
2. What does the post-treatment endoscopic retrograde cholangiopancreatography (ERCP) film (fig 1) show?
   

View larger version (139K): [in this window] [in a new window]   Figure 1 Post-treatment ERCP film.

Relevant Article

Treatment options for common bile duct stones
Postgrad. Med. J. 2003 79: 181. [Extract] [Full Text] [PDF]