Abstract
One hundred consecutive patients were prospectively studied to assess the clinical and biochemical features of symptomatic choledocholithiasis. Biochemical tests were performed during the three days following the onset of symptoms. Pain was the most frequent symptom of choledocholithiasis, observed in 75% of the patients, but rarely occurred alone (12%). Clinical symptoms were not different according to age. High serum gamma glutamyl transpeptidase and alkaline phosphatase were the most frequent biochemical abnormalities in patients with symptomatic choledocholithiasis: they were increased in 94 and 91% of cases, respectively. Only one patient had no biochemical abnormality. Serum transaminases could reach very high levels just as in hepatitis. Biochemical data did not differ regardless of whether the common bile duct was enlarged or not. Biochemical abnormalities had been studied over the first 10 days of spontaneous evolution in 25 patients while choledocholithiasis persisted: serum bilirubin and transaminases significantly decreased while serum gamma glutamyl transpeptidase, alkaline phosphatase, and amylase remained unchanged. These results indicate that, in patients with suggestive symptoms, choledocholithiasis is unlikely in the absence of biochemical abnormalities in the first three days following the onset of symptoms.
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Bartlett MK, Quinby WC: Surgery of the biliary tract. N Engl J Med 256:11–15, 1957
Benhamou JP, Sarles H: Foie, pancréas, voies biliares. 3rd ed. Paris, Flammarion, 1980, pp 196–204
Berk JE: Choledocholithiasis. Am J Surg 155:96–101, 1942
Bockus HL: Gastroenterology, Vol 3, The Liver, Gallbladder, Bile Ducts and Pancreas, 3rd ed. Philadelphia, WB Saunders, 1976, pp 790–810
Caroli J: Les ictères par rétention. Diagnostic médicochirurgical. Paris, Masson, 1956
Sherlock S: Diseases of the Liver and Biliary System, 6th ed. London, Blackwell Scientific Publications, 1981, pp 476–498
Strohl EL, Diffenbaugh WG, Guynn V: Symptoms of common duct stones. Arch Surg 64:788–793, 1952
Thomson FB: Residual stone in the biliary ducts. Surg Gynecol Obstet 103:78–83, 1956
Waugh JM, Johnston EV, Cain JC: Surgical aspects of choledocholithiasis. JAMA 154:734–738, 1954
Grace DM, Henderson AR: Preoperative and postoperative enzymes changes in patients with gallstones. Surg Gynecol Obstet 147:219–224, 1978
Järvinen H: Abnormal liver function tests in acute cholecystitis; the predicting of common duct stones. Ann Clin Res 10:323–327, 1978
Lacaine F, Corlette MB, Bismuth H: Preoperative evaluation of the risk of common bile duct stones. Arch Surg 115:1114–1116, 1980
Mossberg SM, Ross G: High serum transaminase activity associated with extrahepatic biliary disease. Gastroenterology 45:345–353, 1963
Saltzstein EC, Peacock JB, Thomas MD: Preoperative bilirubin, alkaline phosphatase, and amylase levels as predictors of common duct stones. Surg Gynecol Obstet 154:381–384, 1982
Okuda K, Tsuchiya Y: Ultrasonography of the biliary tract. Prog Liver Dis 7:285–297, 1982
Cooperberg PL, Li D, Wong P, Cohen MM, Burhenne HJ: Accuracy of common hepatic duct size in the evaluation of extrahepatic biliary obstruction. Radiology 135:141–144, 1980
Rubin JF, Beal JM: Diagnosis of choledocholithiasis. Surg Gynecol Obstet 156:16–20, 1983
McMahon MJ, Pickford IR: Biochemical prediction of gallstones early in an attack of acute pancreatitis. Lancet 2:541–543, 1979
Desmaizières F, Lacaine F, Huguier M: La cholangiographie peropératoire: Valeur diagnostique dans la lithiase biliaire. Nouv Presse Med 7:1455–1457, 1978
Ginsberg AL: Very high levels of SGOT and LDH in patients with extrahepatic biliary tract obstruction. Am J Dig Dis 15:803–807, 1970
Graham MF, Cooperberg PL, Cohen MM, Burhenne MJ: The size of normal common hepatic duct following cholecystectomy: An ultrasonographic study. Radiology 135:137–139, 1980
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Anciaux, M.L., Pelletier, G., Attali, P. et al. Prospective study of clinical and biochemical features of symptomatic choledocholithiasis. Digest Dis Sci 31, 449–453 (1986). https://doi.org/10.1007/BF01320306
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DOI: https://doi.org/10.1007/BF01320306