[Details of diagnosis and surgical treatment in terminal choledochal lithiasis]

Lithiasis of the terminal choledocus raises problems of pre- and intraoperative diagnosis, especially when the evolution is complicated by sclero-inflammatory of the Oddi, chronic pancreatitis, or acute pancreatitis, or with angiocholitis and hepato-renal failure. The high frequency of the lithiasis of the terminal choledocus (37.72% of all cases of biliary lithiasis) makes necessary an improvement of the methods used for the exploration, and evacuation of this type of lithiasis, and for the recovery of the biliary flow. The clinical syndrome in this biliary lithiasis was predominantly of the painful type (in 20.63% of the patients), of the icteric type (58.75%), of the angiocholitic type (8.75%), or it was dominated by pancreatitis (5.95%) or peritonitis (3.06%). In the 126 cases of lithiasis of the terminal choledocus the authors have applied the following procedures: external biliary drainage (50 cases with one death), choledochduodenostomy (42 cases with 4 deaths), papillosplincterotomy of the Oddi (34 cases with 6 deaths). The high postoperative death rate (8.75%) may be related to the fact that surgery was performed in late stages in patients aged over 50 years, with severe anatomoclinical forms (icterocholangitis), with increased anesthetic and surgical risks, as well as that of postoperative complications.