Choledocholithiasis
Key points
- Choledocholithiasis is the presence of a gallstone in the common bile duct.
- 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.
- The objective of treatment is to remove the obstruction in the bile duct.
- Bile-duct blockage and infection caused by stones in the biliary tract can be a life-threatening illness.
Alternative names
Gallstone in the bile duct; Bile duct stone; Bile calculus; Biliary calculus
Definition
Choledocholithiasis is the presence of a gallstone in the common bile duct. The stone may consist of bile pigments and/or calcium and cholesterol salts that are formed in the biliary tract.
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. Symptoms are usually not present unless obstruction of the common bile duct occurs. Even after the gallbladder is removed, a stone may remain in the common bile duct causing episodic pain or jaundice.
Complete, persistent obstruction of the common bile duct can cause cholangitis, a serious infection of the biliary tree, which is a medical emergency. An obstruction of the common bile duct can also lead to an obstruction of the pancreatic duct, which may cause pancreatitis.
Risk factors include a previous medical history of cholelithiasis (gallstones). The incidence is 6 out of 100,000 people.
Symptoms
- Abdominal pain in the upper right quadrant or the middle of the upper abdomen
o May radiate to the right shoulder
o May be sharp or cramping or dull
o May be recurrent
o May radiate to the back
o Made worse by eating fatty or greasy foods
o Occurs within minutes following meals - Nausea
- Vomiting
- Fever
- Jaundice
- Loss of appetite
Signs and tests
Tests that show the location of stones in the bile duct include the following:
- ERCP (endoscopic retrograde cholangiography)
- Abdominal CT scan
- Abdominal ultrasound
- Percutaneous transhepatic cholangiogram (PTCA)
Other blood tests that may be affected include the following:
- Bilirubin level, elevated
- Liver function tests, with elevated enzyme levels
Treatment
The objective of treatment is to remove the obstruction in the bile duct. Surgical removal of the gallbladder and the stones is one option. Another possibility is removal of the stones by ERCP and sphinterotomy (an incision into the sphinter muscle of the duct).
Written and revised by
David Cohen, M.D.
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