Cholelithiasis

Gallstone disease is a disease caused by the formation of stones in the gallbladder, less often in the hepatic and biliary ducts. After 40 years, stones are found in 32% of women and 16% of men. In the presence of stones, bile infection is noted in 30% of cases. At the heart of stone formation is the imbalance between the bile stabilizers (bile acids and lecithin) and the amount of substances dissolved in it (calcium carbonate, bilirubin and cholesterol).

Symptoms, course. The asymptomatic course of cholelithiasis is rare. As a rule, in most cases it is replaced by typical attacks of biliary colic or acute cholecystitis. The presence of stones is observed on average in 90% of patients with gall bladder cancer, and among patients with cholelithiasis, bladder cancer develops on average in 4-5%. Postoperative mortality among patients with cholelithiasis is almost 10 times lower than in acute cholecystitis. Gallstone disease is an indication for surgery, since surgery before complications is less dangerous.

Complications of cholelithiasis are caused either by the attachment of infection (acute cholecystitis), or by the migration of stones (development of choledocholithiasis, mechanical jaundice), or by a combination of these two moments (acute cholecystitis with obstruction of the cystic duct, cholangitis). Choledocholithiasis can be complicated by papillitis with the development of cicatrical stricture of the falcon nipple.

Diagnosis is based on clinical examination and additional methods of examination of patients. A survey radiographic examination of the abdominal cavity reveals only radiopaque stones, the content of calcium salts in which exceeds 3%. Ultrasound scanning of the gallbladder and biliary tract is very informative (up to 90%) non-invasive method. It can also be used in acute cholecystitis, mechanical jaundice, when oral and intravenous cholegraphy is ineffective. Distinguish direct (the presence of stones in the bladder and ducts) and indirect (the contrast of the bile ducts with the bladder turned off) radiographic signs of cholelithiasis.

Treatment operative-cholecystectomy with intraoperative examination of bile ducts. The latter includes examination, palpation, transillumination of the bile ducts, and intraoperative cholangiography. When a stone is found in the common bile duct, it is opened, the stones removed and the absence of an obstacle to the outflow of bile is monitored by probing the ducts and choledochoscopy.

After choledochotomy, a dull duct seam is rarely used, most often the duct is drained through the stump of the vesicular duct (according to Pikovsky) or T-shaped drainage (according to Keru). When detecting the stricture of the choledochus and its expansion, anastomosis is imposed above the narrowing (for example, holedohoduodenoanastomoz).