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.

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.
Fever
Fever is the temporary increase in the body's temperature in response to a disease or illness. A child has a fever when the temperature is at or abov...
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Yellowing of skin and whites of the eyes (jaundice).
Loss of appetite.
Nausea and vomiting.
Nausea and vomiting
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
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Clay-colored stools.

Exams and Tests

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

Abdominal CT scan
Abdominal CT scan
An abdominal CT scan is an imaging method. This test uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomog...
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Abdominal ultrasound
Abdominal ultrasound
Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and...
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Endoscopic retrograde cholangiography (ERCP)
Endoscopic retrograde cholangiography
ERCP is short for endoscopic retrograde cholangiopancreatography. It is a procedure that looks at the bile and pancreatic ducts. It is done through...
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Endoscopic ultrasound
Magnetic resonance cholangiopancreatography (MRCP)
Percutaneous transhepatic cholangiogram (PTCA)
Percutaneous transhepatic cholangiogram...
A percutaneous transhepatic cholangiogram (PTC) is an x-ray of the bile ducts. These are the tubes that carry bile from the liver to the gallbladder...
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Your health care provider may order the following blood tests:

Bilirubin
Bilirubin
The bilirubin blood test measures the level of bilirubin in the blood. Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. Bi...
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Complete blood count (CBC)
Complete blood count
A complete blood count (CBC) test measures the following:The number of white blood cells (WBC count)The number of red blood cells (RBC count)The numb...
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Liver function tests
Liver function tests
Liver function tests are common tests that are used to see how well the liver is working. Tests include:AlbuminAlpha-1 antitrypsinAlkaline phosphata...
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Pancreatic enzymes (amylase or lipase)
Enzymes
Enzymes are complex proteins that cause a specific chemical change. For example, they can help break down the foods we eat so the body can use them....

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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
ERCP
ERCP is short for endoscopic retrograde cholangiopancreatography. It is a procedure that looks at the bile and pancreatic ducts. It is done through...
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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
Cirrhosis
Cirrhosis is scarring of the liver and poor liver function. It is the last stage of chronic liver disease.
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Cholangitis
Cholangitis
Cholangitis is an infection of the bile ducts, the tubes that carry bile from the liver to the gallbladder and intestines. Bile is a liquid made by ...
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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

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.

Gallstones
Animation

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 - 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 - 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 - 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 - 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 - 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

Gallstones
Animation

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 - 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 - 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 - 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 - 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 - 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

A Closer Look

Review Date: 5/2/2023

Reviewed By: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Choledocholithiasis

Bile

Causes

Gallstones

Symptoms

Fever

Nausea and vomiting

Exams and Tests

Abdominal CT scan

Abdominal ultrasound

Endoscopic retrograde cholangiography

Percutaneous transhepatic cholangiogram...

Bilirubin

Complete blood count

Liver function tests

Enzymes

Treatment

ERCP

Outlook (Prognosis)

Possible Complications

Cirrhosis

Cholangitis

When to Contact a Medical Professional

References

Gallstones

Digestive system - illustration

Digestive system

Kidney cyst with gallstones - CT scan - illustration

Kidney cyst with gallstones - CT scan

Choledocholithiasis - illustration

Choledocholithiasis

Gallbladder - illustration

Gallbladder

Gallbladder - illustration

Gallbladder

Bile pathway - illustration

Bile pathway

Gallstones

Digestive system - illustration

Digestive system

Kidney cyst with gallstones - CT scan - illustration

Kidney cyst with gallstones - CT scan

Choledocholithiasis - illustration

Choledocholithiasis

Gallbladder - illustration

Gallbladder

Gallbladder - illustration

Gallbladder

Bile pathway - illustration

Bile pathway

A Closer Look

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