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Choledocholithiasis

Gallstone in the bile duct; Bile duct stone

Choledocholithiasis is the presence of at least one gallstone in the common bile duct. The stone may be made up of bile pigments or calcium and cholesterol salts.

Causes

About 1 in 7 people with gallstones will develop stones in the common bile duct. This is the small tube that carries bile from the gallbladder to the intestine.

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    Risk factors include a history of gallstones. However, choledocholithiasis can occur in people who have had their gallbladder removed.

    Symptoms

    Often, there are no symptoms unless the stone blocks the common bile duct. Symptoms may include:

    • Pain in the right upper or middle upper abdomen for at least 30 minutes. The pain may be constant and intense. It can be mild or severe.
    • Fever.
    • Yellowing of skin and whites of the eyes (jaundice).
    • Loss of appetite.
    • Nausea and vomiting.
    • Clay-colored stools.

    Exams and Tests

    Tests that show the location of stones in the bile duct include the following:

    Your health care provider may order the following blood tests:

    Treatment

    The goal of treatment is to relieve the blockage.

    Treatment may involve:

    • Surgery to remove the gallbladder and stones
    • ERCP and a procedure called a sphincterotomy, which makes a surgical cut into the muscle in the common bile duct to allow stones to pass or be removed

    Outlook (Prognosis)

    Blockage and infection caused by stones in the biliary tract can be life threatening. Most of the time, the outcome is good if the problem is detected and treated early.

    Possible Complications

    Complications may include:

    When to Contact a Medical Professional

    Contact your provider if:

    • You develop abdominal pain, with or without fever, and there is no known cause
    • You develop jaundice
    • You have other symptoms of choledocholithiasis
    Open References

    References

    Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 146.

    Pattni C, Zenlea T. Choledocholithiasis. In: Ferri FF, ed. Ferri's Clinical Advisor 2023. Philadelphia, PA: Elsevier; 2023:368-369.

    Radkani P, Hawksworth J, Fishbein T. Biliary system. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. St Louis, MO: Elsevier; 2022:chap 55.

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Kidney cyst with gallstones - CT scan

      Kidney cyst with gallstones - CT scan - illustration

      A CT scan of the upper abdomen showing a fist-sized cyst of the left kidney and gallstones (the kidney cyst was found by chance; there were no symptoms).

      Kidney cyst with gallstones - CT scan

      illustration

    • Choledocholithiasis

      Choledocholithiasis - illustration

      About 15% of people with gallstones will develop stones in the common bile duct. The common bile duct is a small tube that carries bile from the gallbladder to the duodenum. Obstruction of the common bile duct may also lead to obstruction of the pancreatic duct because these ducts are usually connected. If the pancreatic duct is also obstructed, pancreatitis will likely develop.

      Choledocholithiasis

      illustration

    • Gallbladder

      Gallbladder - illustration

      The liver produces bile which aids in the digestion of fats. The bile travels through tiny canals which eventually drain through the common bile duct into the small intestine. The gallbladder stores excess bile that is not immediately needed for digestion.

      Gallbladder

      illustration

    • Gallbladder

      Gallbladder - illustration

      The gallbladder is a muscular sac located under the liver. It stores and concentrates the bile produced in the liver that is not immediately needed for digestion. Bile is released from the gallbladder into the small intestine in response to food. The pancreatic duct joins the common bile duct at the small intestine adding enzymes to aid in digestion.

      Gallbladder

      illustration

    • Bile pathway

      Bile pathway - illustration

      The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic duct).

      Bile pathway

      illustration

     

    Review Date: 5/2/2023

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