Choledocholithiasis is when you have a gallstone in your common bile duct. That’s the duct that carries bile from your gallbladder. Gallstones in this narrow passageway pose a risk of obstructing the flow of bile. An obstruction can cause pain, inflammation and serious complications.
Choledocholithiasis is the condition of having a gallstone (or stones) in your common bile duct. “Choledocho” is the Latin term for the common bile duct, and “lithiasis” means stones. Gallstones are pebble-like pieces of concentrated bile materials. They can develop in any place bile flows through.
You may have also heard the term “cholelithiasis,” which is similar. Cholelithiasis is the condition of having gallstones in your gallbladder. Gallstones may develop in your gallbladder or bile ducts, or both. A gallstone that develops in your gallbladder may also travel to your common bile duct.
If you have choledocholithiasis, you have at least one gallstone in your common bile duct. If it’s very small, it may not cause you any problems and may even pass into your intestines. But if it becomes large enough or blocks your common bile duct, it’ll cause symptoms of severe constant pain and jaundice.
Biliary colic is intermittent pain from gallstones that obstruct your biliary system intermittently (off and on). This is more common with gallbladder stones, but can happen with choledocholithiasis if a gallstone obstructs your common bile duct off and on — for example, if it moves in and out of your duct.
A gallstone, or several, in your common bile duct isn’t necessarily an emergency, but it’s a risk. Smaller gallstones may pass safely through your common bile duct to your intestines and out of your body. The risk is that they’ll become stuck there and grow large enough over time to cause a blockage.
Because of this risk, healthcare providers prefer to treat common bile duct stones immediately when they find them. They’ll recommend an endoscopic procedure to examine and, most likely, remove the stones. That means a gastroenterologist will access your bile ducts via a catheter passed down your throat.
If a gallstone stays in your common bile duct and grows large enough to block the flow of bile through the duct, it endangers your entire biliary system. That’s the network of organs and vessels that bile travels through. A blockage can cause inflammation, infection and life-threatening complications.
About 10% of people have gallstones, but most of them form in their gallbladder. About 15% of people with gallstones have them in their common bile duct. Gallstones will never bother most people. Only 20% of people with gallstones will have complications that require treatment.
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You may not have any symptoms. Unless your gallstones cause a blockage, you may never even know they’re there. If you do have symptoms, it means that a stone is blocking your common bile duct. The first sign of a blockage will be the symptoms of biliary colic. These can include:
A gallstone that blocks your common bile duct will cause bile to back up behind the blockage. This can affect all of your ducts and organs connected to it, including your gallbladder, pancreas and liver. It causes inflammation, breeds infection and can lead to long-term tissue damage. Complications include:
Your liver makes bile out of materials it filters from your blood. These materials include cholesterol, bilirubin, bile salts and lecithin. Gallstones occur when there’s too much of one of these — usually cholesterol, but sometimes bilirubin — and the excess materials turn into a kind of sediment.
The sediment collects at the bottom of your gallbladder or your common bile duct and eventually hardens. The stones gradually grow as sediment continues to wash over them. This takes many years. Most gallstones form in your gallbladder and travel with the flow of bile into your common bile duct.
You may be more likely to get a gallstone in your common bile duct if you:
You may be more likely to have gallstones in general if you:
Gallstones in your bile duct usually aren’t discovered unless they cause symptoms. If you seek healthcare for symptoms of biliary colic or jaundice, your healthcare provider will investigate with blood tests and imaging tests. Blood tests will show the buildup of bile, and imaging will find the blockage.
Blood tests may include:
Imaging tests may include:
They usually remove them during an ERCP exam. Doctors can attach special tools to the endoscope to break up and remove the stones when they find them. Sometimes, they make a surgical cut into the muscle of the duct to open it up and allow stones to pass. This is called a sphincterotomy.
The endoscopic procedure (ERCP) doesn’t require cutting into your abdomen to access the bile ducts. However, after removing gallstones from your bile ducts, doctors often recommend surgery to remove your gallbladder. This is to prevent more gallstones from exiting your gallbladder and causing choledocholithiasis again.
Depending on your condition, you may need treatment before your gallstones can be removed, such as:
Short-term complications of endoscopic gallstone removal may include:
Long-term complications after treatment may include:
As cholesterol gallstones are the most common type, you may be able to reduce your risk by reducing cholesterol in your blood through dietary and lifestyle changes. Healthcare providers also recommend that you avoid “yo-yo” dieting and lose weight gradually. Losing too quickly can encourage gallstones.
Treatment is simple and effective for most people. If you’re among the few who have complications afterward, these complications are also treatable. Between 5% and 25% of people may develop new gallstones in their bile ducts within 10 to 20 years. The risk is less if you have your gallbladder removed.
A note from Cleveland Clinic
A gallstone attack can be intense and scary, especially if you didn’t know you had gallstones. The sooner you seek treatment, the sooner you’ll find relief. Always take biliary colic seriously, even if it goes away or isn’t yet severe. An obstruction in your bile duct will only get worse until it’s removed.
Last reviewed by a Cleveland Clinic medical professional on 09/19/2022.
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