What is choledocholithiasis?

Choledocholithiasis (also called bile duct stones or gallstones in the bile duct) is the presence of a gallstone in common bile duct. Gallstones usually form in your gallbladder. The bile duct is the small tube that carries bile from the gallbladder to the intestine. The gallbladder is a pear-shaped organ below your liver in the upper right side of your abdomen. However, about 15 percent of all people with gallstones will have gallstones in the bile duct, or choledocholithiasis

Gallbladder stones with bile duct stones

What are the symptoms? 

Gallstones in the bile duct may not cause symptoms for months or even years in unobstructed. But if a stone  becomes lodged in the duct and obstructs it, you may experience the following:

  • abdominal pain in the right upper or upper abdomen radiating to back
  • fever 
  • jaundice (yellowing of the skin and eyes) 
  • loss of appetite 
  • nausea and vomiting 
  • clay-colored stools

The pain caused by gallstones in the bile duct can be sporadic, or it can linger. The pain may be mild at times and then suddenly severe. Severe pain may require emergency medical treatment. When a gallstone is stuck in the bile duct, the bile can become infected. The bacteria from the infection can spread rapidly, it can become a life-threatening infection. Other possible complications include biliary cirrhosis and pancreatitis.

Diagnosing choledocholithiasis 

  • Transabdominal ultrasound (TUS) 
  • Abdominal CT scan
  • Endoscopic Retrograde Cholangiography (ERCP)
  • Magnetic resonance cholangiopancreatography (MRCP): an MRI of the gallbladder, bile  ducts, and pancreatic duct
  • Blood tests to look for an infection and to check liver and pancreas function:
    1. Complete blood count
    2. Bilirubin
    3. Pancreatic enzymes
    4. Liver function tests 

Treating choledocholithiasis

Treating gallstones in the bile duct focuses on relieving the blockage. These treatments may include: 

  • EPT + stone extraction + CBD stenting 
  • Surgery to remove the gallbladder and stones (Laparoscopic cholecystectomy

The most common treatment for gallstones in the bile duct is biliary endoscopic sphincterotomy (BES). During BES procedure, a balloon- or basket-type device is inserted into the bile duct and used to extract the stone or stones. About 85 percent of bile duct stones can be removed with BES followed by laparoscopic removal of the gallbladder.