CHOLESTEROL BILE-DUCT STONES WITH NO STONES IN THE GALLBLADDER

Common bile duct stones are usually associated with stones in the gall bladder. During the period 1989-1991, however, we encountered 17 patie nts with common bile duct (CBD) stones without gallbladder stones who had presented with obstructive jaundice and cholangitis. Their ages ra nged between 30 and 72 years; 10 were female and seven male. Five of t hem had a deceptive presentation and were initially misdiagnosed as ha ving a malignant lesion. It was endoscopic retrograde cholangiopancrea tography 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 retriev ed. One patient required emergency surgery due to flare-up of cholangi tis. Cholesterol concentration of the retrieved stones was 70-92% of t he dry weight. Thus, these 17 patients formed a distinct subgroup who had cholesterol CBD stones with stoneless gallbladder, and five of the se 17 patients had presentations mimicking malignant lesions.