Obstinate choledocholithiasis occurs when an obstructing common duct stone is large in size and does not easily respond to simple endoscopic or laparoscopic removal techniques. Such stones increase the risk of complications from causing biliary obstruction and from requiring more invasive methods of extraction. Sonography combined with computed tomography can confirm the presence, size, and position of common duct stones under ideal conditions before deciding if and how to treat choledocholithiasis. The sonographer must often battle bowel gas and difficult body habitus to image common duct stones, but it is crucial to document them when possible for proper diagnosis and management.
Tazuma S.: Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). Best Pract Res Cl Ga2006;20:1075-1083.
2.
Ko CW, Lee SP: Epidemiology and natural history of common bile duct stones and prediction of disease. Gastrointest Endosc2002;56(suppl):S165-S169.
3.
Caddy GR, Tham TCK: Symptoms, diagnosis and endoscopic management of common bile duct stones. Best Pract Res Cl Ga2006;20:1085-1101.
4.
Evans JA, Branch MS: The recalcitrant bile duct stone. Tech Gastrointest Endosc2007;9:104-113.
5.
Deziel DJ: Cholelithiasis: incidental and symptomatic, in Myers JA, Millikan KW , Saclarides TK (eds): Common Surgical Diseases: An Algorithmic Approach to Problem Solving. 2nd ed. New York, Springer, 2008, pp 197-200.
6.
Sherlock S, Dooley J (eds): Diseases of the Liver and Biliary System . 11th ed. Malden, MA, Wiley-Blackwell, 2002, pp 563-582.
7.
Scott DR, Craig PI: Role of magnetic resonance cholangiopancreatography and other non-invasive imaging modalities in assessing bile duct stones. J Gastroenterol Hepatol2008;23:679-686.
8.
Shojaiefard A., Esmaeilzadeh M., Ghafouri A., Mehrabi A.: Various techniques for the surgical treatment of common bile duct stones: a meta review. Gastroenterol Res Pract2009;2009:840208.
