[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) › Common bile duct [Digestive system](https://durgical.com/en/anatomy/system/digestive-system/) · [Abdomen](https://durgical.com/en/anatomy/region/abdomen/) # Common bile duct The common bile duct (choledochus) carries bile from the [liver](https://durgical.com/en/anatomy/liver/) and gallbladder down to the duodenum; a stone blocking it causes jaundice. Official name: Bile duct [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=abdomen&select=common_bile_duct&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The main bile duct, running behind the duodenum and through the head of the pancreas to open into the duodenum. ## What it does Carries bile from the liver and gallbladder to the intestine. ## Key points - Charcot triad of ascending cholangitis: fever with chills, jaundice and right upper quadrant pain; Reynolds pentad adds low blood pressure and confusion - Choledocholithiasis: most duct stones come down from the [gallbladder](https://durgical.com/en/anatomy/gallbladder/) (secondary); stones that form in the duct itself (primary) are linked to stasis and infection - Its upper limit of normal width on ultrasound is commonly quoted as about 6 mm, a little more with age and after cholecystectomy ## Key facts **Where** About 6–8 cm: supraduodenal (free edge of lesser omentum, right of hepatic artery, in front of portal vein), retroduodenal, pancreatic, intraduodenal **Function** Carries bile to the duodenum **Drains** [Common hepatic duct](https://durgical.com/en/anatomy/common-hepatic-duct/) and [cystic duct](https://durgical.com/en/anatomy/cystic-duct/) **Into** Joins main [pancreatic duct](https://durgical.com/en/anatomy/pancreatic-duct/) at [hepatopancreatic ampulla](https://durgical.com/en/anatomy/hepatopancreatic-ampulla/), opening on major duodenal papilla (D2) ## Relations **Course** Down the free edge of the [lesser omentum](https://durgical.com/en/anatomy/lesser-omentum/), behind the first part of the [duodenum](https://durgical.com/en/anatomy/duodenum/), then in a groove on (or through) the back of the head of the [pancreas](https://durgical.com/en/anatomy/pancreas/), entering the second part of the duodenum obliquely **Behind** [Portal vein](https://durgical.com/en/anatomy/hepatic-portal-vein/) in the hepatoduodenal ligament, with the epiploic foramen behind the free edge; lower down, the [inferior vena cava](https://durgical.com/en/anatomy/inferior-vena-cava/) behind the pancreatic head **Medial** [Proper hepatic artery](https://durgical.com/en/anatomy/proper-hepatic-artery/) on its left above; the [gastroduodenal artery](https://durgical.com/en/anatomy/gastroduodenal-artery/) nearby behind the first part of the duodenum **In front** First part of the duodenum, then pancreatic tissue where it runs through the head of the pancreas ## How to find it It cannot be felt. In open surgery it lies in the free edge of the lesser omentum, which can be held between finger and thumb through the epiploic foramen (as in the Pringle maneuver); a Kocher maneuver, lifting the duodenum and the pancreatic head, exposes its lower part. ## On imaging Ultrasound measures its width and shows dilation above a block, but often misses distal stones hidden by bowel gas. MRCP shows stones as dark filling defects within bright bile; endoscopic ultrasound picks up small stones well; ERCP is kept for treatment (stone removal, sphincterotomy, stent). ## Common problems - A gallstone stuck in it: jaundice, pain, and sometimes infection (cholangitis) or pancreatitis. - Injury during cholecystectomy (rare but serious). ## How it is diagnosed Blood tests, ultrasound, MRI (MRCP). ## Treatment - Stones removed by ERCP (an endoscope through the mouth to the duodenum), then usually cholecystectomy. ## Clinical notes - Obstructive jaundice: dark urine, pale stools and itching; stones tend to give painful, fluctuating jaundice, tumours painless, progressive jaundice - Ascending cholangitis is obstruction plus infection; draining the duct, usually by ERCP, is the key step together with antibiotics - Choledochal cysts are congenital dilations of the duct (Todani classification) that raise the risk of stones, cholangitis and cancer ## Anatomical variants - Its union with the main pancreatic duct varies: a common channel (most often), separate openings on the same papilla, or rarely separate papillae - A long common channel outside the sphincter (pancreaticobiliary maljunction) is linked to choledochal cysts and gallbladder cancer ## Development Comes from the stalk of the hepatic diverticulum; as the duodenum rotates, its opening moves with the ventral pancreatic bud from the front to the posteromedial wall of the duodenum. ## Related conditions - [Gallstones (cholelithiasis)](https://durgical.com/en/conditions/gallstones/) - [Choledocholithiasis](https://durgical.com/en/conditions/choledocholithiasis/) - [Acute cholangitis](https://durgical.com/en/conditions/acute-cholangitis/) - [Pancreatic cancer](https://durgical.com/en/conditions/pancreatic-cancer/) - [Gallbladder cancer](https://durgical.com/en/conditions/gallbladder-cancer/) - [Primary sclerosing cholangitis](https://durgical.com/en/conditions/primary-sclerosing-cholangitis/) - [Cholangiocarcinoma (bile duct cancer)](https://durgical.com/en/conditions/cholangiocarcinoma/) - [Choledochal cyst](https://durgical.com/en/conditions/choledochal-cyst/) - [Liver fluke infections (fascioliasis, clonorchiasis, opisthorchiasis)](https://durgical.com/en/conditions/liver-fluke-infections/) - [Biliary atresia](https://durgical.com/en/conditions/biliary-atresia/) ## Test yourself Think of the answer, then tap the question to see it. ## What is Charcot triad? Fever with chills, jaundice and right upper quadrant pain: ascending cholangitis; Reynolds pentad adds low blood pressure and confusion. ## What is the course of the common bile duct? Down the free edge of the lesser omentum, behind D1, through or behind the head of the pancreas, joining the pancreatic duct to open on the major papilla in D2. ## How does jaundice from a common bile duct stone usually differ from a tumour? Stones tend to give painful, fluctuating jaundice; tumours painless, progressive jaundice. ## Which test shows common bile duct stones without instrumenting the duct? MRCP, showing stones as dark filling defects in bright bile; ERCP is kept for treatment. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/bile-duct/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** ductus biliaris TA2 3103 **Official Spanish (DeCS)** Conducto colédoco DeCS D003135 **English (TA2)** Bile duct ## Related - [Pancreatic duct](https://durgical.com/en/anatomy/pancreatic-duct/) - [Lesser omentum](https://durgical.com/en/anatomy/lesser-omentum/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=3166); [Anatomy, Abdomen and Pelvis: Biliary Ducts](https://www.ncbi.nlm.nih.gov/books/NBK459246/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/bile-duct/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/bile-duct/