CLINICAL, RADIOLOGICAL AND INTRA-OPERATIVE PREDICTORS OF CHOLEDOCHOLITHIASIS: A PROSPECTIVE STUDY
Background- CBD stones are a frequent complication in cholelithiasis & biliary pancreatitis. Accurate preoperative diagnosis aids in deciding the modality of intervention.
Material and Methods - We did a prospective study in a tertiary care hospital to determine the clinical, biochemical, radiological and intra-operative predictors of choledocholithiasis.
Results – Data of 134 patients with cholecystitis over a 2-year period was collected. With median age being 41.5 years, majority 99 (73.8%) were women. 55 patients had clinical indicators of choledocholithiasis, while 79 had none. Most common presentation was jaundice 30 (54.5%). Cholangitis had the highest specificity (100%) and an accuracy of 79.9%. Of patients with clinical indicators, 44 cholangiograms suggested stones, of which 41 was confirmed. Palpable stone in CBD was the best sensitivity 93%, specificity 100%, PPV 100%, NPV 96.8% and accuracy of 97.8%. Prior pancreatitis and cystic duct diameter of >4mm were the poorest predictorsConclusion – Intra-op assessment was found to have the best sensitivity. Clinical criteria predict choledocholithiasis fairly accurately (false negative rate of 1.49%).
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