Choledocholithiasis

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.

Choledocholithiasis Symptoms

There are few, if any, noticeable symptoms of choledocholithiasis, unless the stone blocks the common bile duct. If blockage and/or infection does occur, it can be life-threatening. However, the outcome is typically good if the problem is detected and treated early. 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 (yellowing of skin and whites of the eyes)
  • Loss of appetite
  • Nausea and vomiting
  • Clay-colored stools

Choledocholithiasis Diagnosis

Your doctor may order blood tests to check:

  • Bilirubin
  • Complete blood count (CBC)
  • Liver function
  • Pancreatic enzymes

To confirm size and location of any gallstones, as well as any blockage of the bile ducts, you may also have imaging tests including CT scans, MRIs, or endoscopic studies using ultrasound or X-rays and a thin, flexible tube with a lighted camera on the end that is inserted down your throat while you are under sedation.

Choledocholithiasis Treatments

  • Endoscopic retrograde cholangiopancreatography (ERCP) – ERCP uses an endoscope and X-ray to examine the ducts that drain the liver, gallbladder and pancreas. ­
    • During an ERCP, your physician may be able to remove gallstones using a balloon or cage, eliminating the need for any future surgery.
    • Large stones often can be broken into pieces with a smaller camera that goes into the bile duct and a probe that delivers shock waves to crack the stone.
  • Surgical removal of your gallstone – Recommended for recurrent gallstones or persistent blockage of bile ducts. Depending on your individual situation, this could be either minimally invasive surgery or more traditional, open surgery. ­ Fortunately, a person can live without a gallbladder, as bile has other ways to reach the small intestine.

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