Identifying Patients at Low Risk for Common Bile Duct Lithiasis

Patients with biliary stone disease at low risk for common bile duct lithiasis can be identified preoperatively by noninvasive methods.

Patient evaluation:

(1) history and physical examination

(2) serum biochemistries

(3) ultrasound

Definition of low-risk group:

(1) no jaundice

(2) normal transaminase levels (AST and ALT)

(3) a common bile duct diameter < 8 mm on ultrasound

(4) no intrahepatic duct enlargement on ultrasound

Risk Group	Acute Gallbladder Complications	Risk of Common Bile Duct Lithiasia
low	present	1%
low	absent	5%
not low	NA	39%

where:

• Acute gallbladder complications include acute cholecystitis or hydrocholecystitis.

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