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Ultrasound fails to detect a CBD stone in a jaundiced patient with elevated liver enzymes in about 50% 75% cases, , although it may detect dilatation of the CBD or the intrahepatic biliary radicals.
Despite not performing IOC, our bile duct injuries were in line with previous studies and we only had one patient with a retained CBD stone.
ERCP revealed CBD stone in 9 (90%) and a plastic biliar y stent in 1 (10%), successful cannulation was achieved in all.
Table 1: Parameters at presentation AGE/SEX Diagnosis Bilirubin ALP CBD size by PCV PT ratio (mg%) T C (iu/l) USS (mm) (%) 36/F CBD stone 16.
I perform it in patients I identify preoperatively as being at high risk for having a CBD stone based upon the presence of abnormal liver function tests, a dilated CBD upon ultrasound, and jaundice or pancreatitis.
Three further patients required open CBD exploration after unsuccessful endoscopic CBD stone extraction; this included a patient with an impacted Dormia basket.
9 The standard technique of CBD stone extraction comprise of endoscopic billiary sphinterotomy which widens the billiary orifice using electro-coagulation current, followed by removal of stones with balloon-tip catheters and /or Dormia basket.
We used only through-the-scope mechanical lithotriptor in 4 cases of large CBD stone.
There is dispute regarding the optimal treatment for concomitant gallstones and CBD stone.
Fifty one patients had secondary stones and one patient had primary CBD stone presenting 25yrs.
CONCLUSION: CBD stone with ascariasis should be considered in patient complaining of pain abdomen and other biliary symptoms in post-cholecystectomy and post choledocolithotomy patients.
No single blood test or combination of blood tests can predict whether or not a CBD stone is present.
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