Diagnosis of choledocholithiasis.

A review of the records of 75 consecutive patients with a discharge diagnosis of choledocholithiasis has been conducted. Clinical assessment as well as laboratory assessment of patients who are suspected of having common duct calculi continues to present significant problems in diagnostic accuracy. More than 90 per cent of the patients who presented with Charcot's triad of pain, fever and jaundice had common duct calculi; however, only one-fourth of the patients in our study with choledocholithiasis had this combination of symptoms. Imaging techniques before operation are associated with a significant incidence of false-negative and false-positive findings. Palpation of the common duct and cholangiography at the time of operation remain the most reliable means of detecting choledocholithiasis.