Choledocholithiasis

Choledocholithiasis (also called bile duct stones or gallstones in the bile duct) is the presence of a gallstone in the common bile duct. Gallstones usually form in your gallbladder. The gallbladder is a pear-shaped organ below your liver in the upper-right side of your abdomen. These stones usually remain in the gallbladder or pass through the common bile duct unobstructed. The bile duct is the small tube that carries bile from the gallbladder to the intestine.

Causes

Gallstones often pass through the common bile duct unnoticed. However, about 15 percent of all people with gallstones will have gallstones in the bile duct. There are two types of gallstones: cholesterol stones and pigment stones. Scientists believe that cholesterol stones are caused by bile that contains:

  • too much cholesterol
  • too much bilirubin
  • not enough bile salts

They may also occur if the gallbladder does not empty completely or often enough. The cause of pigment stones is not known. They seem to occur in people who have:

  • cirrhosis of the liver
  • biliary tract infections
  • hereditary blood disorders in which the liver makes too much bilirubin

Symptoms

Gallstones in the bile duct may not cause symptoms for months or even years. However, if the blockage becomes severe, you may experience the following:

  • abdominal pain in the upper or middle-upper abdomen
  • fever
  • jaundice (yellowing of the skin and eyes)
  • loss of appetite
  • nausea and vomiting

When a gallstone is stuck in the bile duct, the bile can become infected. The bacteria from the infection can spread rapidly. It can move into the ductal system and then into the liver. It can become a life-threatening infection.

The pain caused by gallstones in the bile duct can be sporadic, or it can linger. The pain may also be mild at times and then suddenly severe. Severe pain may require emergency medical treatment. (The most severe symptoms are commonly confused with a cardiac event.)

Treatment:

Treating gallstones in the bile duct focuses on relieving the blockage. These treatments may include:

  • stone extraction
  • fragmenting stones (lithotripsy)
  • surgery to remove the gallbladder and stones (cholecystectomy)
  • surgery that makes a cut into the common bile duct to remove stones or help them pass (sphincterotomy)
  • biliary stenting

The most common treatment for gallstones in the bile duct is biliary endoscopic sphincterotomy (BES). During a BES procedure, a balloon- or basket-type device is inserted into the bile duct and used to extract the stone or stones.

If a stone does not pass on its own or cannot be removed with BES, doctors may use lithotripsy. This procedure is designed to fragment stones so they can be captured or passed easily. Patients with gallstones in the bile duct and gallstones still in the gallbladder may be treated with cholecystectomy (gallbladder removal). While performing the surgery, your doctor will also inspect your bile duct to check for remaining gallstones.

If stones cannot be removed completely or you have a history of gallstones causing problems but do not wish to have your gallbladder removed, your doctor may place biliary stents (tiny tubes to open the passage). These will provide adequate drainage and help prevent future choledocholithiasis episodes. The stents can also prevent biliary sepsis (inflammation) and infection.