About 15% of people with gallstones will develop the stones in the common bile duct, a 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. An obstruction of the common bile duct can also lead to an obstruction of the pancreatic duct because these ducts are connected in most people. Such an obstruction can 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
  • may radiate to the right shoulder
  • may be sharp or cramping or dull
  • may be recurrent
  • may radiate to the back
  • made worse by fatty or greasy foods
  • occurs within minutes following meals
• nausea
• vomiting
• fever
• jaundice
• loss of appetite

Tests that show location of stones in the bile duct include:

• ERCP (endoscopic retrograde cholangiography)
• abdominal CT scan
• abdominal ultrasound
• percutaneous transhepatic cholangiogram (PTCA)

Other blood tests that may be affected include:

• bilirubin level, elevated
• liver function tests, with elevated enzyme levels

The objective of treatment is to remove the obstruction in the bile duct. Surgical removal of the gallbladder and the stones is also recommended. Removal of the stones by ERCP, which is also a diagnostic procedure to determine the cause and location of obstruction, may be recommended where the procedure is available.

Bile-duct blockage caused by stones in the biliary tract can be a life-threatening illness. With prompt diagnosis and treatment, the outcome is usually very good.

• biliary cirrhosis
• cholangitis

Call for an appointment with your health care provider if abdominal pain with or without fever develops that is not attributed to other causes, jaundice develops, or if other symptoms suggestive of choledocholithiasis develop.