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Epidemiology and disease characteristics of symptomatic choledocholithiasis in Sri Lanka
Ann Hepatobiliary Pancreat Surg 2019 Feb;23(1):41-5
Published online February 28, 2019;
Copyright © 2019 Korean Association of Hepato-Biliary-Pancreatic Surgery.

Waduthanthri Supun Lakmal De Silva1, Ajith Aloka Pathirana2, Thejana Kamil Wijerathne2, Bawantha Dilshan Gamage2, Buddhika Kemiya Dassanayake3, and Mohan Malith De Silva2

1Post Graduate Institute of Medicine, University of Colombo, 2Department of Surgery, Faculty of Medical Sciences, University of Sri Jayewardenepura, Colombo, 3Department of Surgery, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
Received September 12, 2018; Revised October 5, 2018; Accepted October 7, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Backgrounds/Aims: Published data on choledocholithiasis in Sri Lanka is scarce. This study was conducted to determine epidemiological, clinical and endoscopic characteristics of choledocholithiasis in Sri Lanka.
Methods: This was a retrospective study of consecutive patients for a period of three years until April 2016. The sample included patients from many parts of the island. Patients were selected from the endoscopy database of the unit and the data were collected from the records of the patients.
Results: A total of 253 patients were included in the study. The mean age of the patients was 53.6 years. Patients presented with obstructive jaundice (58.5%), cholangitis (25.3%), biliary colic or upper abdominal pain (14.2%) and acute biliary pancreatitis (1.8%). There were 26 (10.3%) post cholecystectomy patients. Concomitant gallbladder stones were found in 173 patients (68.4%). Juxta-papillary diverticula were found in 36 patients (14.2%). Twenty-one (8.3%) and nine patients (3.6%) were found to have choledochal cysts and common bile duct strictures, respectively. Stones were commonly found in the distal common bile duct (68.4%). A majority of the patients had a single stone (47.8%). In 209 patients (79.6%), the size of the largest stones measured between 0.5-1.5 cm.
Conclusions: Choledocholithiasis is a disease affecting middle-aged population with predominance among females in Sri Lanka. Patients with symptomatic choledocholithiasis commonly present with obstructive jaundice. In the present study, most of the stones were formed in anatomically normal biliary systems. Stones were predominantly distal, single and measured 0.5-1.5 cm in size. The observed features were favorable features for successful endoscopic clearance. None of the patients included in the study had primary CBD stones according to the available criteria.
Keywords : Common bile duct stones; Symptomatic choledocholithiasis; Choledocholithiasis in Sri Lanka;Juxta-papillary diverticula; Primary common bile duct stones


February 2019, 23 (1)