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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 1 in 7 people with gallstones will develop stones in the common bile duct. This is 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:

Often, there are no 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 pain may be constant or cramping. It can feel sharp or dull.
  • Fever
  • Yellowing of skin and whites of the eyes (jaundice)
  • Loss of appetite
  • Nausea and vomiting
  • Clay-colored stools
Exams and Tests:

Tests that show the location of stones in the bile duct include the following:

Your doctor may order the following blood tests:

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. Most of the time, the outcome is good if the problem is detected and treated early.

Possible Complications:
When to Contact a Medical Professional:

Call 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:

Jackson PG, Evans SRT. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 18th ed. St. Louis, Mo: WB Saunders; 2012:chap 55.

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.


Review Date: 7/18/2013
Reviewed By: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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