What is a major complication of choledocholithiasis?

• A. Acute pancreatitis
• B. Chronic cholecystitis
• C. Ascending cholangitis
• D. Pseudocyst formation

Answer: (C)

Ascending cholangitis is a significant complication associated with choledocholithiasis, which refers to the presence of stones in the common bile duct. The pathophysiology involves obstruction of the bile duct by gallstones, leading to bile stasis, increased pressure in the biliary tree, and the potential for bacterial overgrowth. As bile is stagnant, infections can occur, resulting in cholangitis—a clinical syndrome characterized by the classic triad of fever, jaundice, and right upper quadrant pain, though it can present variably.

When choledocholithiasis leads to cholangitis, it poses serious health risks which can necessitate urgent intervention, including endoscopic retrograde cholangiopancreatography (ERCP) or surgery to relieve the obstruction and address the infection.

While acute pancreatitis can occur due to gallstone obstruction of the pancreatic duct, it is a less direct consequence compared to cholangitis since it often results from gallstones impacting the pancreas rather than the bile duct itself. Chronic cholecystitis pertains to inflammation of the gallbladder, and pseudocyst formation factors into complications of pancreatitis rather than choledocholithiasis directly. Hence, ascending cholangitis stands out as the major complication