Management of stone impacted at distal common bile duct        WANG Jian, ZHANG Xi-wen, WANG Hao-lu. Department of General Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
Corresponding author：WANG Jian, E-mail: dr_wangjian@yahoo.com.cn
Abstract    Stone impacted at distal common bile duct is common and inappropriate treatment would result in a high rate of injury in choledocho-pancreatico-duodenal junction. Magnetic resonance cholangiopancreatography (MRCP) shows advantages in managements selecting, which can reveal where the stone impacted, how extent the bile duct dilated, and whether cholecystolithiasis, intrahepatic lithiasis or periampullary diverticula accompanied. Different treatments should be determined by patient’s condition such as general condition, severity of cholecystitis and specification. The principle of choice in treatment is to minimize the wound and decrease the rate of complication. So endoscopy is preferable. Damage control surgery to relieve the biliary obstruction should be firstly considered in patients with acute obstructive suppurative cholangitis or pancreatitis. There is no need to remove the stone completely at once.