Transabdominal Ultrasonography in Symptomatic Choledocholithiasis – Usefulness in Settings with Limited Resources

Abstract

Objective: Ultrasonography remains the initial imaging modality in the management of biliary disease. This study is designed to evaluate the accuracy of transabdominal ultrasonography in diagnosing biliary pathology in patients with choledocholithiasis. Methods: This was a retrospective study of a continuous sample of patients over a period of 3 years ending in January 2016; these patients were referred for endoscopic management of choledocholithiasis to a tertiary care hospital in Colombo, Sri Lanka. Ultrasound reporting was carried out by different consultant radiologists at both the index and the referring hospitals. The findings of endoscopic retrograde cholangiograms were compared with the ultrasound scan (USS) results. Results: A total of 247 patients were included in the study. USS was 97.4% accurate in detecting intrahepatic duct dilatation (IHDD). Stone counts and the location of stone(s) in the USSs correlated strongly with the number of stones delivered during endoscopic removal and their location in cholangiograms (P < 0.001). The difference in mean diameter of the common bile duct (CBD) of patients with choledochal cysts (CCs) (18.57 mm) and of patients without them (12.39 mm) is statistically significant (P < 0.001). At 14.5 mm, the negative predictive value for a CC is 99.02%. Conclusion: Ultrasonography is a reliable tool in predicting IHDD, stone count, and the location of stones in the biliary tree, particularly in a resource-poor setting. A CBD diameter of 14.5 mm in transabdominal ultrasound scan can be used as a cutoff for predicting extrahepatic CC.

A Nomogram for Predicting the Risk of Common Bile Duct Stones Based on Preoperative Laboratory Tests and Ultrasonography 

“…In this study, we used the univariate and multivariate logistic regression analysis to determine the predictive factors for CBD stone. Our results revealed that multiple gallbladder stones, the maximal diameter of CBD stone measured by preoperative ultrasonography, preoperative GGT level and DB/TB ratio were independent predictors of CBD stone, which had been reported by previous studies [17][18][19]. * US, Ultrasonography; US Positive indicates that imaging examination revealed CBD stone; CBDD, the value of maximal CBD dimeter measured on the Ultrasonography; ALT, alanine aminotransferase; AST, aspartate aminotransferase; ALP, alkaline phosphatase; GGT, glutamyl transpeptidase; TB, total bilirubin; DB, direct bilirubin; HR, hazard ratio; CI, confidence interval; P-value<0.05 indicates statistical significance.…”

“…In this study, we used the univariate and multivariate logistic regression analysis to determine the predictive factors for CBD stone. Our results revealed that multiple gallbladder stones, the maximal diameter of CBD stone measured by preoperative ultrasonography, preoperative GGT level and DB/TB ratio were independent predictors of CBD stone, which had been reported by previous studies [17][18][19]. Based on the these variables, we developed a nomogram model and the results…”

General complication of laparoscopic surgery, necesary review

“…This is often detected when introducing the optic and observing that it is not in the abdominal cavity, making it necessary to communicate this space with the intra-abdominal space. (16,17,18) 2 -Typical of Pneumoperitoneum:…”

Urgent ultrasonographic diagnostics in acute nontraumatic abdominal conditions (emergency abdominal ultrasound)

“…Poznati Šarkoov trijas akutno nastalog bola u gornjem desnom kvadrantu, groznice i ikterusa, klinički ukazuje na akutno nastalu bilijarnu opstrukciju sa razvojem ascendentnog holangitisa. Iako je ultrazvuk visoko senzitivan i specifičan u detekciji kalkuloze žučne kese, njegova uloga u evaluaciji holedoholitijaze i druge bilijarne patologije nije precizno definisana, budući da su Slika 1: Akutni kalkulozni holecistitis -patološka distenzija lumena žučne kese u kojem se vide kalkulusi (inklaviran u vratu -zvezdica) uz zadebljao i raslojen zid (strelica) druge metode, poput magnetno rezonantne holangiopankreatografije (MRCP) i endoskopske retrogradne holangiopankreatografije (ERCP), preciznije 7 . Dilatacija intrahepatičnih žučnih puteva ukazuje na bilijarnu opstrukciju i lako se detektuje ultrasonografski, jer su nedilatirani žučni putevi promera 1 do 2 mm i teško se vizuelizuju, navodeći radiologa na detekciju uzroka same opstrukcije 2 .…”