Definition

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.

Alternative Names

Gallstone in the bile duct; Bile duct stone

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.

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:

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

Your health care provider may order the following blood tests:

• Bilirubin
• Complete blood count (CBC)
• Liver function tests
• Pancreatic enzymes (amylase or lipase)

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:

• Biliary cirrhosis
• Cholangitis
• Pancreatitis

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

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.