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Choledocholithiasis

Definition

Choledocholithiasis is the presence of a gallstone in the common bile duct. The stone may consist of bile pigments or calcium and cholesterol salts.

Alternative Names

Gallstone in the bile duct; Bile duct stone

Causes, incidence, and risk factors

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.

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

Symptoms

Symptoms usually do not occur unless the stone blocks the common bile duct. Symptoms that may occur include:

• Abdominal pain in the right upper or middle upper abdomen that may:
  • Come and go
  • Be sharp, cramping, or dull
  • Spread to the back or below the right shoulder blade
  • Get worse after eating fatty or greasy foods
  • Occurs within minutes of a meal
• Fever
• Loss of appetite
• Jaundice (yellowing of skin and whites of eyes)
• Nausea
• Vomiting

Signs and tests

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

• Abdominal CT scan
• Abdominal ultrasound
• Endoscope retrograde cholangiography (ERCP)
• Endoscopic ultrasound
• Magnetic resonance cholangiopancreatography (MRCP)
• Percutaneous transhepatic cholangiogram (PTCA)

Your doctor may order the following blood tests:

• Bilirubin
• Liver function tests
• Pancreatic enzymes

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

Support Groups

Expectations (prognosis)

Blockage and infection caused by stones in the biliary tract can be life threatening. However, with prompt diagnosis and treatment, the outcome is usually very good.

Complications

• Biliary cirrhosis
• Cholangitis
• Pancreatitis

Calling your health care provider

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.

Prevention

References

Verma D. EUS vs MRCP for detection of choledocholithiasis. Gastrointest Endosc. 2006;64(2):248-254.

Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap. 54.

Afdhal N. Diseases of the gallbladder and bile ducts. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 159.