Clinical, biochemical and radiological correlation in choledocholithiasis

Background: Choledocholithiaisis is one of the most commonly encountered clinical entities and also one of the most commonly missed; which is most unfortunate as it is potentially curable condition. Primary choledocholithiasis is less common and occurs in the setting of bile stasis, resulting in higher propensity for intraductal stone formation. Older adults with large bile ducts and peri-ampullary diverticula are at elevated risk for formation of primary CBD stones. Methods: Our present study was carried out in 100 patients, admitted in surgery department with signs and symptoms suggestive of gallstone disease. Selection of patient was done on basis of inclusion criteria. Laboratory tests, and USG was done in all patients while MRCP was done in selected patients who fulfilled a certain criteria. All the patients underwent definitive surgery and surgical findings were considered the final results for evaluation. Results: Pain abdomen is the most common presenting symptom of Gallstone disease with associated fever (27%) and jaundice (40.9%) showeing statistical significance in patients of choledocholithiasis.ALP and transminases showed similar sensitivity of 72.73% for diagnosis of choledocholithiasis, while ALP showed highest specificity (97.44%) among laboratory parameters in choledocholithiasis patients.USG sensitivity in diagnosing choledlithiasis was 100% while, in diagnosing choledocholithiasis, it was 80.7%.MRCP showed highest sensitivity (95.65%) and highest specificity (100%) for diagnosis of choledocholithiasis. Conclusion: MRCP should be considered as the most accurate diagnostic tool for preoperative diagnosis of choledocholithiasis.