Bile Duct Obstruction

A bile duct obstruction occurs when a blockage or narrowing in your bile ducts prevents bile from flowing as it should. Gallstones are the most common cause. Treatment involves identifying what’s causing the blockage and removing it to prevent serious complications.


A gallstone creating an obstruction in the common bile duct
Gallstones are the most common cause of bile duct obstructions.

What is a bile (biliary) duct obstruction?

A bile duct obstruction is a blockage in your bile ducts. Bile is a digestive juice that breaks down fats. It also contains a waste product called bilirubin.

Your bile ducts are the tiny canals that allow bile to flow from your liver (where it’s made) to your gallbladder (where it’s stored) to your small intestine (where it helps with digestion). Bile ducts also help move bilirubin out of your liver.

Blockages in your bile ducts can slow or stop the flow of bile. This can cause bile to back up and collect in your liver. The results can feel painful and pose serious health risks without treatment.

How common are bile duct obstructions?

Obstructions are the most common problem that can affect your bile ducts. Approximately 5 in 1,000 people develop gallstones that end up leading to an obstruction. Gallstones are hardened collections of bile. Gallstones are the most common cause of bile duct obstructions.


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Symptoms and Causes

What are the symptoms of a blocked bile duct?

Symptoms are similar to those associated with gallstones and jaundice. Jaundice symptoms are a sign that there’s too much bilirubin in your bloodstream.

Signs to look out for include:

What causes bile duct blockages?

Causes of a bile duct obstruction include:

  • Gallstones in your bile duct.
  • Choledochal cysts (a rare congenital condition where cysts slow the flow of bile).
  • Bile duct strictures (abnormal narrowing in a bile duct related to a condition or scarring).

Bile duct strictures can result from a range of conditions (both malignant and benign). They can happen when there’s scarring after a medical procedure, like gallbladder removal surgery (cholecystectomy).

Causes of bile duct strictures that may lead to an obstruction include:


What are the complications of a bile duct obstruction?

An obstruction can cause bile to build up in your liver. This can lead to severe inflammation and even life-threatening infections without treatment. It can also lead to permanent liver scarring (cirrhosis of the liver) that can lead to liver failure without proper management.

If the bile gets stuck in the part of the ducts near your gallbladder, you can get a gallbladder infection (cholecystitis).

Not having enough bile can also prevent your small intestine from digesting fats. This can lead to malnutrition.

Diagnosis and Tests

How is a bile duct obstruction diagnosed?

Your provider will review your medical history, including your symptoms and medications. They’ll perform a physical exam to check for signs of an obstruction, like tenderness or swelling in your abdomen. You’ll need blood tests and imaging to confirm the obstruction and determine what caused it.

Blood tests

Blood tests can reveal signs of an obstruction. Tests your provider may order include:

Imaging tests

You’ll need imaging tests if blood test results indicate a possible obstruction. You may need one or more of these imaging tests:

  • Ultrasound: An ultrasound uses sound waves to show images of the inside of your body. It can reveal irregularities that indicate an obstruction. You may need an endoscopic ultrasound, abdominal ultrasound or liver ultrasound.
  • Abdominal computed tomography (CT) scan: A CT scan uses X-rays and computers to create detailed images. It can rule out causes of your symptoms that may not show up on an ultrasound.
  • Endoscopic retrograde cholangiopancreatography (ERCP): An ERCP can diagnose and treat causes of an obstruction. During the test, your provider will gently insert a lighted, flexible tube (endoscope) down your esophagus until it reaches your bile ducts. They may use instruments inside the endoscope to remove tissue for a biopsy or to fix the obstruction. You’ll be sedated during this procedure.
  • Magnetic resonance cholangiopancreatography (MRCP): This advanced MRI records images of your bile ducts while a special dye travels through them. Like an ERCP, it can show the causes of bile duct obstructions, like gallstones or strictures. But it’s less invasive than an ERCP.
  • Hepatobiliary iminodiacetic acid (HIDA) scan: A HIDA scan records images while a radioactive tracer travels through your bile ducts. It can show causes of obstructions, like gallbladder problems or congenital disorders that cause strictures.
  • Percutaneous transhepatic cholangiography (PTC): A PTC uses an ultrasound or X-rays to record images, while a dye travels through your bile ducts and into your small intestine. The dye reveals blocked parts of your ducts.


Management and Treatment

How do you unblock your bile duct?

Treatment for a bile duct obstruction depends on how urgently you need care and what’s causing the blockage.

Treatments include:

  • ERCP: Your provider may remove gallstones from your bile ducts during an ERCP (endoscopic retrograde cholangiopancreatography). The endoscope contains instruments that allow your provider to crush and remove the stones.
  • Gallbladder removal surgery: You may need your gallbladder removed if you get frequent gallstones that cause obstructions. Usually, it involves minimally invasive surgery called laparoscopy. You can live a healthy life without a gallbladder.
  • Stents: Your provider may insert a metal or plastic tube called a stent inside your bile ducts to widen them or keep them open. You may need a stent if strictures are causing an obstruction.
  • Cancer treatments: You may need surgery or other cancer treatments, like chemotherapy and radiation, if a tumor is causing the obstruction.


Can bile duct obstructions be prevented?

You can’t always prevent a bile duct obstruction.

But you can reduce your risk of the biggest cause (gallstones) by reducing the foods you eat that are high in cholesterol. You can reduce your risk of several liver conditions that can lead to strictures by:

  • Getting plenty of exercise.
  • Eating nutritious meals that are low in saturated fat.
  • Maintaining a weight that’s healthy for you.
  • Avoiding alcohol or drinking alcohol only in moderation.

Outlook / Prognosis

What is the outlook for a bile duct obstruction?

Your prognosis depends on what’s causing the obstruction. For example, prompt diagnosis and treatment can prevent complications from causes like gallstones. With treatment, many people recover completely.

Bile duct obstructions related to cancer and chronic liver disease may be more difficult to manage.

Everyone’s situation is different. Your healthcare provider will explain what you should expect from treatment based on what’s causing the blockage and how it’s impacting your health.

Living With

When should I see my healthcare provider?

See your healthcare provider if you’re experiencing symptoms of a bile duct blockage. Many conditions can cause some of the common symptoms (like abdominal pain, nausea and vomiting). It’s important to confirm that the issue is a blockage sooner rather than later — before bile builds up and causes complications.

Is a blocked bile duct an emergency?

It can be, especially if backed-up bile leads to severe inflammation and infection. It’s best to see a provider when you first notice symptoms to prevent this from happening.

A note from Cleveland Clinic

Your body depends on the free flow of bile through your bile ducts to aid in digestion and to remove bilirubin (a waste product) from your body. This is why it’s so important to fix any blockages. You need bile to arrive at your small intestine to break down fats. You need bilirubin to move out of your liver so it doesn’t cause complications, like liver disease or an infection. Your healthcare provider can discuss best options for removing a blockage if you have one.

Medically Reviewed

Last reviewed on 01/30/2024.

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