Prospective diagnosis of choledocholithiasis.

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Abstract
Eighty-seven consecutive patients with biliary sympatomatology that was later confirmed at surgery were prospectively studied by ultrasonography to determine the presence or absence of choledocholithiasis prior to surgery. Preoperative sonographic analysis yielded an overall detection rate for choledocholithiasis of 13%. Fifty-six of 87 patients (64%) had dilated extrahepatic ducts. In 11 of 56 patients (20%) an intraluminal stone was seen. Thirty-one of 87 patients (36%) had nondilated ducts both at ultrasonography and at surgery. No common bile duct stones were seen prior to surgery in those patients. Seven of 66 patients (11%) with intact gallbladders failed to demonstrate any evidence of gallstones at ultrasonography, yet choledocholithiasis was found at surgery. Findings in these patients emphasize the limited role of biliary ultrasound in excluding the diagnosis of choledocholithiasis.