Health Encyclopedia

Choledocholithiasis

Definition

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

Alternative Names

Gallstone in the bile duct; Bile duct stone; Bile calculus; Biliary calculus

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 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.

References

Verma D. EUS vs MRCP for detection of choledocholithiasis. Gastrointest Endosc. Aug 2006; 64(2): 248-54.

Chari RS, Shah SA. Biliary System. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery, 18th ed. St. Louis, M0: WB Saunders; 2008: chap. 54.

Diseases of the Gallbladder and Bile Ducts. In: Goldman L, Ausiello D, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap. 159.

Review Date:6/3/2008
Reviewed By:Linda Vorvick, MD, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

ADAM Quality A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is the first of its kind, requiring compliance with 53 standards of quality and accountability, verified by independent audit. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial process. A.D.A.M. is also a founding member of Hi-Ethics (www.hiethics.com) and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.