Choledocholithiasis

• Illustrations
• Alternative names
• Definition
• Causes, incidence, and risk factors
• Symptoms

• Signs and tests
• Treatment
• Expectations (prognosis)
• Complications
• Calling your health care provider

Alternative names    Return to top

Definition    Return to top

Choledocholithiasis is the presence of a gallstone in the common bile duct. The stone may consist of bile pigments and/or calcium and cholesterol salts that are formed in the biliary tract.

Causes, incidence, and risk factors    Return to top

About 15% of people with gallstones will develop stones in the common bile duct, the small tube that carries bile from the gallbladder to the intestine. Symptoms are usually not present unless obstruction of the common bile duct occurs. Even after the gallbladder is removed, a stone may remain in or develop in the common bile duct causing pain or jaundice.

Complete, persistent obstruction of the common bile duct can cause cholangitis, a life threatening infection of the biliary tree, which is a medical emergency. An obstruction of the common bile duct can also lead to an obstruction of the pancreatic duct, which may cause pancreatitis.

Risk factors include a previous medical history of cholelithiasis (gallstones).

Symptoms    Return to top

• Abdominal pain in the upper right quadrant or the middle of the upper abdomen
  • May radiate to the right shoulder
  • May be sharp or cramping or dull
  • May be recurrent
  • May radiate to the back
  • Made worse by eating fatty or greasy foods
  • Occurs within minutes following meals
• Nausea
• Vomiting
• Fever
• Jaundice
• Loss of appetite

Signs and tests    Return to top

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

• ERCP (endoscopic retrograde cholangiography)
• MRCP (magnetic resonance cholangiopancreatography)
• Abdominal CT scan
• Abdominal ultrasound
• Percutaneous transhepatic cholangiogram (PTCA)

Other blood tests that may be affected include the following:

• Bilirubin level, elevated
• Liver function tests
• Pancreatic enzymes

Treatment    Return to top

The goal of treatment is to relieve the obstruction in the common bile duct. Surgical removal of the gallbladder and the stones (via either an open procedure or a laparoscopic procedure) is one option. Another possibility is removal of the stones by ERCP and sphinterotomy (an incision into the sphinter muscle of the duct).

Expectations (prognosis)    Return to top

Bile-duct blockage and infection caused by stones in the biliary tract can be a life-threatening illness. With prompt diagnosis and treatment, the outcome is usually very good.

Complications    Return to top

• Biliary cirrhosis
• Cholangitis

Calling your health care provider    Return to top

Call for an appointment with your health care provider if abdominal pain with or without fever develops that is not attributable to other causes, if jaundice develops, or if other symptoms suggestive of choledocholithiasis occur.