Presence of a gallstone in the common bile duct

Choledocholithiasis is the presence of at least one gallstone in the common bile duct, the small tube that carries bile from the gallbladder to the intestine. Although risk factors include a history of gallstones, choledocholithiasis can also occur in people who have had their gallbladder removed.

There are few if any 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 type of pain ranges from constant to cramping to sharp to dull.)
  • Fever
  • Jaundice, or yellowing of skin and whites of the eyes
  • Loss of appetite
  • Nausea and vomiting
  • Clay-colored stools

Blockage and infection caused by stones in the biliary tract can be life-threatening. Most often, the outcome is good if the problem is detected and treated early.

Diagnosis

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

Patients with symptomatic cholelithiasis can try decreasing the amount of fat in their diet to control the symptoms. Often, they need to have their gallbladder removed. Or they may undergo 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.

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