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Diagnosis and management of common bile duct stones in patients with sickle hemoglobinopathies
R E Ware1, W H Schultz, H C Filston
1Department of Pediatrics, Duke University Medical Center, Durham, NC.
Insights
Common bile duct (CBD) stones are frequent in sickle cell disease patients with gallstones. Diagnostic methods like ultrasound are unreliable; intraoperative cholangiography and ERCP are sensitive for detecting CBD stones.
Area of Science:
- Gastroenterology
- Hepatology
- Hematology
Background:
- Sickle hemoglobinopathies are associated with an increased risk of cholelithiasis.
- The presence of common bile duct (CBD) stones in these patients is often overlooked.
- Accurate diagnosis of CBD stones is crucial for appropriate management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of various methods for detecting CBD stones in patients with sickle hemoglobinopathies and cholelithiasis.
- To describe the management of these patients.
- To emphasize the importance of a high index of suspicion for CBD stones in this population.
Main Methods:
- Retrospective review of 35 patients with sickle hemoglobinopathies and cholelithiasis.
- Analysis of diagnostic tools including historical information, physical examination, laboratory tests, ultrasonography, intraoperative cholangiography, and endoscopic retrograde cholangiopancreatography (ERCP).
Main Results:
- Nine out of 35 patients (25.7%) had concomitant CBD stones.
- Clinical assessment and routine tests were insufficient for accurate diagnosis.
- Ultrasonography showed low sensitivity (3 of 8 patients correctly identified).
- Intraoperative cholangiography and ERCP demonstrated high sensitivity for CBD stone detection.
Conclusions:
- CBD stones are relatively common in patients with sickle cell disease and cholelithiasis.
- Clinicians should maintain a high index of suspicion for CBD stones in this patient group.
- Sensitive imaging modalities like intraoperative cholangiography and ERCP are recommended for diagnosis.
Abstract:
Nine of 35 patients with sickle hemoglobinopathies and cholelithiasis were found to have concomitant common bile duct (CBD) stones. We describe the diagnosis and management of these patients with CBD stones. Historical information, physical examination, and routine laboratory tests were unable to identify accurately the patients with CBD stones. Similarly, ultrasonography of the hepatobiliary system was an insensitive method for detecting CBD stones, as only 3 of 8 patients were correctly identified. In contrast, both an intraoperative cholangiogram and endoscopic retrograde cholangiopancreatography were sensitive procedures for detection of CBD stones. We conclude that CBD stones are relatively common in patients with sickle cell disease and cholelithiasis, and clinicians should have a high index of suspicion for their presence.