Cholesterol bile duct stones with no stones in the gallbladder

Common bile duct stones are usually associated with stones in the gallbladder. During the period 1989-1991, however, we encountered 17 patients with common bile duct (CBD) stones without gallbladder stones who had presented with obstructive jaundice and cholangitis. Their ages ranged between 30 and 72 years; 10 were female and seven male. Five of them had a deceptive presentation and were initially misdiagnosed as having a malignant lesion. It was endoscopic retrograde cholangiopancreatography that correctly diagnosed the presence of CBD stones in all 17 patients. Therapeutic sphincterotomy led to subsidence of cholangitis in 16 patients and retrieval of stones in 13 of them. Three patients required nasobiliary decompression because stones could not be retrieved. One patient required emergency surgery due to flare-up of cholangitis. Cholesterol concentration of the retrieved stones was 70-92% of the dry weight. Thus, these 17 patients formed a distinct subgroup who had cholesterol CBD stones with stoneless gallbladder, and five of these 17 patients had presentations mimicking malignant lesions.