Cotton Criteria for Predicting

Choledocholithiasis
 Cotton Criteria for Predicting
Choledocholithiasis
RISK FOR CBD STONES
Low Probability Intermediate High Probability
Probability
Clinical features – Nil Transient Present
jaundice,
pancreatitis,
cholangitis
Liver function tests Normal Less than twice More than twice
– bilirubin, ALP normal normal
USS findings of CBD </ 7mm 8-10mm 10mm
diameter
 Criteria of Possible
Choledocholithiasis
RISK FOR CBD STONES
Clinical presentation Jaundice
Acholic stools/dark urine
Pancreatitis
Cholangitis
Pre-operative investigations CBD diameter >10mm
CBD calculi
Serum ALP >250 U/L
Serum bilirubin >25 umol/L
Intra-operative findings CBD diameter >10-12mm
Cystic duct diameter >4-5mm
Palpable CBD calculi