Effect of the Diameter of the Common Bile Duct on the Incidence of Bile Duct Stones in Patients with Recurrent Attacks of Right Epigastric Pain After Cholecystectomy Juha M. Gro Ènroos, Markku M. Haapama Èki and Risto Gullichsen From the Department of Surgery, University of Turku, Finland Eur J Surg 2001; 167: 767–769 ABSTRACT Objective: To study the relationship between the diameter of the common bile duct and the incidence of bile duct stones in non-jaundiced patients with recurrent attacks of right epigastric pain after cholecystectomy. Design: Retrospective study. Setting: University hospital, Finland. Subjects: 57 consecutive, non-jaundiced patients admitted for elective endoscopic retrograde cholangiopancreatography (ERCP) because of attacks of right epigastric pain after cholecystectomy. Interventions: Measurement of maximum diameter of the common bile duct and presence or absence of bile duct stones. Main outcome measures: Diameter of bile duct (10 mm or less was regarded as normal) and presence or absence of stones. Results: 33 patients had normal-sized bile ducts and in 24 they were widened. Only 2/33 patients with normal-sized ducts (6%) had stones, compared with 11/24 (46%) with wide ducts (p = 0.0008). However, the degree of ductal dilatation did not seem to have any inuence on the presence or absence of stones. Conclusions: Bile duct stones are unlikely after cholecystectomy in patients who are not jaundiced and have a normal-sized common bile duct. However, nearly half of the patients with a wide common bile duct had stones, but the degree of dilatation was not important. Key words: abdominal pain, bile duct stones, biliary tract, cholecystectomy, cholestasis, common bile duct, epigastric pain, gallstones. INTRODUCTION Attacks of right epigastric pain usually cease after cholecystectomy for gallstones. However, in a number of patients attacks recur. Recurrent attacks may indicate the presence of bile duct stones or attacks may have their origin other than in the biliary tract. In a patient planned for elective cholecystectomy for gallstones, a dilated common bile duct accurately predicts bile duct stones (3, 9). However, in patients with gallstone pancreatitis, the diameter of the common bile duct does not predict bile duct stones (4). We wondered what was the case in patients with recurrent attacks of right epigastric pain after cholecystectomy. In a number of these patients dilatation of the common bile duct is explained only as a normal postoperative state after cholecystectomy and the recurrent attacks may be caused by something other than bile disorder, but in some cases dilatation of the common bile duct and attacks of pain are caused by bile duct stones. The aim of the present work was to study the relationship between the diameter of the common bile duct and the presence of bile duct stones in non-jaundiced patients with recurrent attacks of right epigastric pain after cholecystectomy. PATIENTS AND METHODS The study group comprised 57 consecutive non- jaundiced patients admitted to the University Central Hospital of Turku (1000-bed teaching hospital serving an area of 435 000 inhabitants in South-western Fin- land) during the years 1995–1999 for elective endo- scopic retrograde cholangiopancreatography (ERCP) because of recurrent attacks of right epigastric pain after cholecystectomy. All the ERCPs were done by the authors. The interval between the primary operation and ERCP varied between one month and 40 years. There were 41 women and 16 men, median age 63 years (range 22–84). Patients were positioned on the left side during the ERCP. The maximum diameter of the common bile duct was measured at ERCP and considered to be widened when it was more than 10 mm. According to the ERCP ndings the study group was divided into two groups: those whose Ó 2001 Taylor & Francis. ISSN 1102–4151 Eur J Surg 167 ORIGINAL ARTICLE