Concluded Case

Non - Obstructive CBD calculi - Approach?

47 years old female with history of pain right hypochondriac off and on since 2 years . USG - was done - it was case of Cholelithiasis with choledocolothiasis with out obstructive jaundice. A MRCP was done , which showed multiple 2 mm small calculi in mid and distal CBD .But there is no obstructive jaundice. CBD is 5.2 mm . As there is no jaundice and CBD calculi are small in size with no obstriction . Is ERCP clearance of CBD is mandatory or conservative treatment? If any can be tried which causes spontaneous passage of CBD calculi. As calculi smaller than 4 mm can pass spontaneously. Has any one experience of conservative treatment of such a case and treatment protocol in such a case - although cholecystectomy can be done electively at any stage

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Concluded answer
Common bile duct calculi not causing obstructive jaundice need to be treated because of following reasons 1) Most of the calculi in common bile duct originate from gall bladder. Primary common bile duct stones are rare. Therefore, if there are common bile duct calculi present, they are derived from gall bladder. There always remains a possibility that larger gall stone calculi from gall bladder can come in common bile duct causing obstructive jaundice 2) Small bile duct calculi can cause spasm of sphincter of ODDI, this may cause blockage of pancreatic duct causing Acute pancreatitis which can be severe. Therefore, CBD calculi need to be treated Optimum treatment involves ERCP , sphincterotomy and removal of calculi, stenting followed by laparoscopic cholecystectomy
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Common bile duct calculi not causing obstructive jaundice need to be treated because of following reasons 1) Most of the calculi in common bile duct originate from gall bladder. Primary common bile duct stones are rare. Therefore, if there are common bile duct calculi present, they are derived from gall bladder. There always remains a possibility that larger gall stone calculi from gall bladder can come in common bile duct causing obstructive jaundice 2) Small bile duct calculi can cause spasm of sphincter of ODDI, this may cause blockage of pancreatic duct causing Acute pancreatitis which can be severe. Therefore, CBD calculi need to be treated Optimum treatment involves ERCP , sphincterotomy and removal of calculi, stenting followed by laparoscopic cholecystectomy
Yes agreed it is a c/o nonobstructive cholelithiasis and spontaneous passage Sir no definite protocol in such situation We can continue Tab UDCO 300mg 1bd
Thank you doctor
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Udiliv 300 bd homeopathy chew tds mixture of chelidonium30 cardus30 cholestrium30 sizewas 12 mm after2 month7 mm orther pt totally cleared it is for small multiple stones & unfit for surgery pt better get operated chances of CA gall bladder stones can be passed up to pancrease so better cholecystectomy
Surgical procedure is best

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