Definition of Choledocholithiasis:

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

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

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.