ISSN 2415-3060 (print), ISSN 2522-4972 (online)
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УЖМБС 2020, 5(2): 97–103
Clinical Medicine

Diagnosis of Microcholedocholithiasis in Patients with Acute Calculous Cholecystitis

Terletskiy O. M., Kolomiytsev V. I., Omelyanenko O. V., Bufan M. M.

Choledocholithiasis with a detection rate from 8 to 33% is one of the forms of cholelithiasis. In all cases of choledocholithiasis, 5-30% of the disease is asymptomatic or oligosymptomatic characterized only by general nonspecific signs, which have no diagnostic value and are out of surgeons’ sight in the case of urgent surgical pathology, i.e. acute calculous cholecystitis. Namely, microcholedocholithiasis is often the cause of postcholecystectomy syndrome, obstructive jaundice, cholangitis, idiopathic acute pancreatitis, and its relapses, and it can lead to chronic pancreatitis as well. The purpose of the study was to determine the diagnostic value of microscopic examination of ductal bile by polarization and phase-contrast microscopy in patients with microcholedocholithiasis in the settings of urgent surgery. Material and methods. The study included 79 patients who underwent treatment at the Surgical Clinic No.1 of Danylo Halytsky Lviv National Medical University in 2017-2018. The patients were divided into three groups: group I (n=26) had patients with acute calculous cholecystitis and oligosymptomatic choledocholithiasis; group II (n=32) included patients with acute calculous cholecystitis, clinical symptoms of choledocholithiasis (jaundice), and signs of choledocholithiasis by endoscopic retrograde cholangiopancreatography; group III (n=21) encompassed patients with the postcholecystectomy syndrome. The study also included 24 volunteers without the hepatobiliary diseases who were undergoing treatment at the gastroenterology department of Lviv City Clinical Hospital No.5. They constituted the control group IV. Results and discussion. The results of the microscopic examination of bile are as follows: crystalline structures were detected in 25 (96.1%) patients of group I, in 31 (96.8%) – II, in 20 (95.2%) – III, and in 3 (12.5%) volunteers of group IV. Biliary crystals were not detected in 3 (3.7%) patients with diseases of the hepatobiliary system (patients in groups I, II, and III) and 21 (87.5%) volunteers in group IV. The fourth stage of microcholedocholithiasis was detected in 17 (65.3%) patients of group I, in 24 (56.2%) - II, and in 12 (57.1%) patients of group III. In the control group IV, the first stage of microcholedocholithiasis was detected only in 3 (12.5%) patients, crystalline structures in bile were not detectedin the remaining 21 (87.5%) volunteers. Conclusion. Diagnosis of microcholedocholithiasis involves the sequential application of transabdominal ultrasound, methods of direct staining of the biliary tract and the use of polarization microscopy of bile. The information obtained from the results of the microscopic examination of bile can be used as an important criterion for determining the indications for endoscopic transpapillary intervention.

Keywords: microcholedocholithiasis, microscopy of bile, acute calculous cholecystitis

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