Choledocholithiasis
Gallstone in the bile duct; Bile duct stone; Common bile duct stone
Choledocholithiasis means there is at least one gallstone in the common bile duct. The stone may be made up of bile pigments or calcium and cholesterol salts and are called common bile duct stones.
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.
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).
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.
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.
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.
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).
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. The pain may radiate to the back in the area of the right shoulder blade.
- 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 cholangiopancreatography (ERCP)
- Endoscopic ultrasound
- Magnetic resonance cholangiopancreatography (MRCP) -- this is the most accurate non-invasive test to look for a common bile duct stone
- Percutaneous transhepatic cholangiogram (PTC)
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 of the common bile duct.
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, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 141.
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.
Wang D Q-H, Afdhal NH. Gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 65.
Version Info
Last reviewed on: 4/21/2025
Reviewed by: Todd Eisner, MD, Private practice specializing in Gastroenterology in Boca Raton and Delray Beach, Florida at Gastroenterology Consultants of Boca Raton. Affiliate Assistant Professor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
