Choledocholithiasis

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 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 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:
  • Be steady
  • Be sharp, cramping, or dull
  • Spread to the back or below the right shoulder blade
• Fever
• Loss of appetite
• Jaundice (yellowing of skin and whites of eyes)
• Nausea andvomiting

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 doctor may order the following blood tests:

• Bilirubin
• Complete blood count (CBC)
• 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 to allow stones to pass or be removed

Outlook (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.

Possible Complications

• Biliary cirrhosis
• Cholangitis
• Pancreatitis

When to Contact a Medical Professional

Call for an appointment with your health care 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

Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2008:chap. 54.

Glasgow RE, Mulvihill SJ. Treatment of gallstone disease. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 66.

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