Choledocholithiasis is a medical term that refers to the presence of gallstones in the common bile duct, which carries bile from the liver to the gallbladder and small intestine. A gallstone can form in the bile duct itself or travel from the gallbladder into the duct. Stones cause blockages that can eventually lead to irritation, infection, and scarring of the bile ducts. Choledocholithiasis can usually be resolved by a gastroenterologist when the condition is discovered early.
A gallstone can be composed of cholesterol, calcified minerals, or bile pigment that has been hardened by bacteria. Stones that develop in the bile duct are usually the result of bacterial infections, while stones that migrate from the gallbladder are typically buildups of cholesterol and calcium. The most significant risk factors for developing choledocholithiasis are being female, obese, and over the age of 60, though a person of any age and either sex can have a gallstone.
In its early stages, choledocholithiasis may not cause any physical symptoms. As a stone grows and causes a blockage, a person is likely to experience sharp abdominal pains, nausea, vomiting, and fever. An individual may also lose his or her appetite and feel fatigued. Jaundice can set in as a blockage worsens, and a total blockage presents the possibility of a rupture, scarring, and infection. A person who experiences any possible symptoms of choledocholithiasis should visit a doctor as soon as possible to avoid potentially life-threatening complications.
When a primary care physician suspects choledocholithiasis, he or she will refer the patient to a specialist for a more detailed evaluation. A gastroenterologist usually conducts an abdominal ultrasound to look for a blockage and collects a blood sample to check for the presence of bile. The doctor often performs an additional diagnostic test called endoscopic retrograde cholangiopancreatography (ERCP) to pinpoint the location of a gallstone and check for ruptures. During ERCP, a long tube called an endoscope is inserted down the throat and directed to the gallbladder to release a type of dye that can be detected on an x-ray.
Most cases of choledocholithiasis can also be treated with ERCP. The doctor feeds thin instruments through the endoscope to locate and break up the blockage. A more invasive surgical procedure may be necessary to remove a very large stone or one that is not resolved by ERCP. Following surgery, a patient is usually given antibiotics and pain medications, and is generally reevaluated to make sure the gallbladder has not been damaged. A person who has a gallstone is at a high risk of developing more stones in the future, though medications and frequent checkups can help prevent another instance of choledocholithiasis.