Abstract:

Currently, the combination of acute cholecystitis complicated by choledocholithiasis is quite common.

Aim: was to improve the efficiency of diagnosis of complicated forms of gallstone disease (acute cholecystitis complicated by choledocholithiasis).

Materials and methods: study included 118 patients with acute cholecystitis complicated by choledocholithiasis. The age of patients ranged from 16 to 92 years (mean age 61,5 ± 2,5 years). Women were 86(78.5%), men - 32 (21.5%). All patients underwent ultrasound examination of the abdominal cavity, hepatobiliary scintigraphy (HBSG), MRI-cholangiography (MRHG), endoscopic retrograde cholangiopancreatography (ERCP) and biochemical blood tests with determination of total bilirubin, amylase, alanine aminotransferase (ALT) and aspartate aminotransferase (AST), alkaline phosphatase (ALP), total protein and protein fractions.

Results: in the diagnosis of choledocholithiasis sensitivity of ultrasound was 86%; HBSG - 97% MRHG - 92%. Basing on these data of sensitivity of different diagnostic methods, we developed diagnostic algorithm of acute cholecystitis complicated by choledocholithiasis: US → HBSG (if inefficient US ir terms of visualization of the distal common bile duct) → MRHG (to clarify causes of focal disorders of transport of labeled bile, according to HBSG) → ERCP: endoscopic papillosphincterotomy (EPST) and lithoextraction (LE) (detected choledocholithiasis or lingering doubts in the diagnosis).

Conclusions: the use of the diagnostic algorithm for acute cholecystitis in many cases allows timely identification of choledocholithiasis, followed by the implementation of adequate endoscopic sanitation of biliary tract, before performing cholecystectomy . 

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