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Choledocholithiasis: (Bile duct stones, gallstones)
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.


The biliary system is comprised of the organs and duct system that create, transport, store and release bile into the duodenum for digestion. Includes the liver, gallbladder and bile ducts (named the cystic, hepatic, common, and pancreatic 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. 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.


  • Abdominal pain in the upper right quadrant or the middle of the upper abdomen
  • 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)
  • 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).

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