[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Conditions](https://durgical.com/en/conditions/) › Choledocholithiasis

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# Choledocholithiasis

Choledocholithiasis means stones in the common bile duct, the tube that carries bile to the gut; they can block it and cause jaundice or infection.

Updated 2026-10-29

## Structures involved

Tap one to see what it is and open it in 3D.

- [Common bile duct](https://durgical.com/en/anatomy/bile-duct/)
- [Ampulla of Vater](https://durgical.com/en/anatomy/hepatopancreatic-ampulla/)
- [Common hepatic duct](https://durgical.com/en/anatomy/common-hepatic-duct/)
- [Gallbladder](https://durgical.com/en/anatomy/gallbladder/)
- [Cystic duct](https://durgical.com/en/anatomy/cystic-duct/)
- [Pancreatic duct](https://durgical.com/en/anatomy/pancreatic-duct/)
- [Duodenum](https://durgical.com/en/anatomy/duodenum/)
- [Liver](https://durgical.com/en/anatomy/liver/)

## In biochemistry

- [Liver function tests: reading the pattern](https://durgical.com/en/biochemistry/topics/liver-function-tests-reading-the-pattern/)
- [Alkaline phosphatase (ALP) as a lab test](https://durgical.com/en/biochemistry/topics/alkaline-phosphatase-as-a-lab-test/)
- [Gamma-glutamyl transferase (GGT) as a lab test](https://durgical.com/en/biochemistry/topics/gamma-glutamyl-transferase-as-a-lab-test/)

## In the clinical exam

- [Jaundice: prehepatic, hepatic and posthepatic](https://durgical.com/en/clinical-exam/jaundice-prehepatic-hepatic-and-posthepatic/)

## In physiology

- [Bile and the enterohepatic circulation](https://durgical.com/en/physiology/bile-and-the-enterohepatic-circulation/)

## Why it happens

- [Heme breakdown and bilirubin](https://durgical.com/en/biochemistry/pathways/heme-breakdown-and-bilirubin/)
- [Gallbladder and bile ducts](https://durgical.com/en/histology/gallbladder-and-bile-ducts/)

## What it is

Presence of stones in the common bile duct. Most come from the [gallbladder](https://durgical.com/en/anatomy/gallbladder/) (secondary); fewer form in the duct itself (primary).

## Who gets it

Found in a significant minority of people with symptomatic gallstones, more often with age. Because gallstones are common in Colombia, it is a frequent reason for ERCP.

## Causes

- Gallbladder stones that pass through the [cystic duct](https://durgical.com/en/anatomy/cystic-duct/) (secondary, most common)
- Primary duct stones, usually brown pigment, from bile stasis and infection
- Duct strictures, dilatation or parasites (for example Ascaris) that promote stone formation

## Risk factors

- Gallbladder stones
- Older age
- Previous cholecystectomy (retained or recurrent stones)
- Biliary strictures or periampullary diverticula
- Biliary parasitic infection

## Pathophysiology

A stone in the common bile duct blocks bile flow into the [duodenum](https://durgical.com/en/anatomy/duodenum/). Bile backs up, bilirubin and liver enzymes rise and the duct dilates. Stagnant bile can become infected (cholangitis), and a stone at the ampulla can also block the [pancreatic duct](https://durgical.com/en/anatomy/pancreatic-duct/) (pancreatitis).

## Classification

- Secondary (from the gallbladder) or primary (formed in the duct)
- Asymptomatic or symptomatic
- Risk of a duct stone graded low, intermediate or high (ASGE criteria); criteria vary between guidelines

## Symptoms and signs

- Biliary-type pain in the right upper quadrant or epigastrium
- Jaundice that may come and go
- Dark urine and pale stools
- Itching (pruritus)
- Nausea and vomiting; some stones are found with no symptoms

## Red flags

- Fever with chills plus jaundice (cholangitis)
- Severe epigastric pain radiating to the back (pancreatitis)
- Confusion or low blood pressure

## Diagnosis

**Clinical**
Suspected in a patient with gallstones and jaundice or abnormal [liver](https://durgical.com/en/anatomy/liver/) tests. Risk is graded from clinical, lab and ultrasound findings to choose the next test.

**Tests**
Liver tests with a cholestatic pattern: raised bilirubin, alkaline phosphatase and gamma-glutamyl transferase; transaminases may rise early. Lipase if pancreatitis is suspected.

**Imaging**
Ultrasound shows a dilated [common bile duct](https://durgical.com/en/anatomy/bile-duct/) and sometimes the stone. MRCP or endoscopic ultrasound confirm it in intermediate risk; ERCP is both diagnostic and therapeutic in high risk.

## Differential diagnosis

- Pancreatic head or periampullary cancer
- Cholangiocarcinoma
- Benign biliary stricture
- Mirizzi syndrome
- Viral or drug-induced hepatitis
- Primary sclerosing cholangitis

## Goal of treatment

Clear the bile duct, prevent cholangitis and pancreatitis, and remove the gallbladder to stop new stones.

## Treatment

**Acute**
Supportive care: fluids, analgesia, and antibiotics if there are signs of infection.

**Procedure**
ERCP with sphincterotomy and stone extraction is the main treatment; large stones may need lithotripsy or a temporary stent.

**Surgical**
Laparoscopic cholecystectomy, usually during the same admission after the duct is cleared; some surgeons explore the duct during the operation.

**Procedure**
When ERCP fails or is not possible: percutaneous transhepatic drainage or surgical bile duct exploration.

## Complications

- Acute cholangitis
- Acute pancreatitis
- Secondary biliary cirrhosis with long-standing obstruction
- Liver abscess
- Complications of ERCP: pancreatitis, bleeding, perforation

## Prognosis

Very good when the duct is cleared and the gallbladder removed. Untreated obstruction can lead to cholangitis, pancreatitis or chronic liver damage.

## Prevention

- Cholecystectomy in people with symptomatic gallstones reduces later duct stones

## Test yourself

Think of the answer, then tap the question to see it.

## What lab pattern suggests a stone in the common bile duct?

A cholestatic pattern: raised bilirubin, alkaline phosphatase and gamma-glutamyl transferase, sometimes with an early rise in transaminases.

## Which test both confirms and treats choledocholithiasis?

ERCP, with sphincterotomy and stone extraction.

## What non-invasive test confirms a bile duct stone in intermediate-risk patients?

MRCP (magnetic resonance cholangiopancreatography); endoscopic ultrasound is an alternative.

## Which two serious complications can a common bile duct stone cause?

Acute cholangitis (infection of obstructed bile) and acute pancreatitis (blockage at the ampulla).

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/conditions/choledocholithiasis/)

## Related conditions

- [Gallstones (cholelithiasis)](https://durgical.com/en/conditions/gallstones/)
- [Acute cholangitis](https://durgical.com/en/conditions/acute-cholangitis/)
- [Acute pancreatitis](https://durgical.com/en/conditions/acute-pancreatitis/)
- [Acute cholecystitis](https://durgical.com/en/conditions/acute-cholecystitis/)
- [Pancreatic cancer](https://durgical.com/en/conditions/pancreatic-cancer/)
- [Gallbladder cancer](https://durgical.com/en/conditions/gallbladder-cancer/)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: [Choledocholithiasis](https://www.ncbi.nlm.nih.gov/books/NBK441961/) (StatPearls (NCBI Bookshelf), 2026).

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Source: https://durgical.com/en/conditions/choledocholithiasis/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/conditions/choledocholithiasis/