Acute Presentations of Bile Duct Calculi

The majority of bile duct stones in Western patients originate in the gallbladder. Many patients with bile duct stones are asymptomatic. However, the acute complications of bile duct calculi-jaundice, cholangitis, and pancreatitis-may present in insolation or in combination with each other. Successful treatment of cholangitis and severe biliary pancreatitis requires urgent biliary decompression, which is best achieved by endoscopic sphincterotomy. Similarly, endoscopic sphincterotomy is the most appropriate method of relieving obstructive jaundice caused by biliary stones and, in some patients, may be the sole treatment required. Surgical intervention rarely is necessary in the acute stage, although definitive surgery may be required later, when the patient's clinical condition has improved.