Treatment: Choledocholithiasis/Cholangitis

Laparoscopic cholecystectomy and ERCP have decreased the need for choledocholithotomy and T-tube drainage of the bile ducts. When CBD stones are suspected prior to laparoscopic cholecystectomy, preoperative ERCP with endoscopic papillotomy and stone extraction is the preferred approach. CBD stones should be suspected in gallstone pts with (1) history of jaundice or pancreatitis, (2) abnormal LFT, and (3) ultrasound evidence of a dilated CBD or stones in the duct. Cholangitis treated like acute cholecystitis; no oral intake, hydration, analgesia, and antibiotics are the mainstays; stones should be removed surgically or endoscopically.