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.
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.
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 and intense. It can be mild or severe.
- Fever.
- Yellowing of skin and whites of the eyes (jaundice).
- Loss of appetite.
- Nausea and vomiting.
- Clay-colored stools.
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
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.
Call your 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
Gallstone in the bile duct; Bile duct stone
Fogel EL, Sherman S. Diseases of the gallbladder and bile ducts. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 146.
Li S, Zenlea T. Choledocholithiasis. In: Ferri FF, ed. Ferri's Clinical Advisor 2022. Philadelphia, PA: Elsevier; 2022:368-369.
Radkani P, Hawksworth J, Fishbein T. Biliary system. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 21st ed. Philadelphia, PA: Elsevier; 2022:chap 55.
Updated by: Michael M. Phillips, MD, Emeritus Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
On this page
- What are common bile-duct stones?
- What are the benefits of surgery?
- Are there any alternatives to surgery?
- What does the operation involve?
- What complications can happen?
- How soon will I recover?
- Related information on Australian websites
This page will give you information about a cholecystectomy and exploration of the bile duct. If you have any questions, you should ask your GP or other relevant health professional.
What are common bile-duct stones?
Common bile-duct stones are gallstones that move out of your gallbladder and get stuck in your common bile duct, which is a tube that connects your gallbladder to your intestines. Gallstones are ‘stones’ that form in your gallbladder. They are common and can run in families.
Your liver produces a fluid called bile that is concentrated by, and stored in, your gallbladder.
When you eat food, your gallbladder empties bile into your intestines to help digest fats. Stones can develop in bile, particularly if you eat a diet rich in fat.
What are the benefits of surgery?
You should be free of pain and able to eat a normal diet. Surgery should also prevent the serious complications that common bile-duct stones can cause.
Are there any alternatives to surgery?
An ERCP (endoscopic retrograde choledocho pancreatogram) is a procedure to examine your bile duct using a flexible telescope and dye (colourless contrast fluid).
It is possible to dissolve the stones or even shatter them into small pieces but these techniques involve unpleasant drugs that have side effects and a high failure rate.
Antibiotics can be used to treat any infection of your gallbladder and common bile duct. Eating a diet low in fat may help to prevent attacks of pain.
What does the operation involve?
The operation is performed under a general anaesthetic and usually takes 1 to 2 hours.
Your surgeon will first need to find out where the stones are in your common bile duct.
If your surgeon finds any gallstones in the duct, they will try to remove them through the cystic duct using a wire basket, or by using a tube with an inflatable balloon at the end (balloon catheter).
Your surgeon will remove your gallbladder. They will free up and secure your gallbladder duct (cystic duct) and artery, separate your gallbladder from your liver, and remove it.
What complications can happen?
Some complications can be serious and can even cause death.
General complications of any operation
- pain
- bleeding
- infection of the surgical site (wound)
- unsightly scarring of your skin
- developing a hernia in the scar
- blood clot in your leg
- blood clot in your lung
Specific complications of this operation
Keyhole surgery complications
- damage to structures such as your bowel, bladder or blood vessels
- developing a hernia near one of the cuts
- surgical emphysema (crackling sensation in your skin caused by trapped carbon dioxide gas)
Bile duct exploration complications
- retained stones in your common bile duct
- stones forming again in your common bile duct
- narrowing of your common bile duct
- allergic reaction to the equipment, materials, medication or dye
- leaking of bile after the tube is removed
- infection of your skin around the tube
- difficulty removing the tube
Cholecystectomy complications
- leaking of bile or stones
- continued pain
- needing to go to the toilet more often
- inflammation of the lining of your abdomen
- bowel injury
- continued bowel paralysis (ileus), where your bowel stops working for more than a few days
- serious damage to your liver or its associated blood vessels
- tissues can join together in an abnormal way
How soon will I recover?
You should be able to go home after 1 to 2 days if you had keyhole surgery or after 4 to 5 days if you had open surgery.
You should be able to return to work after 3 to 4 weeks, depending on how much surgery you need and your type of work.
Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.
You should make a full recovery and be able to return to normal activities and eat a normal diet.
Summary
Gallstones are a common problem. An operation to remove your gallbladder and any stones in your common bile duct should result in you being free of pain and able to eat a normal diet.
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