Common bile duct stones or Choledocholithiasis

Choledocholithiasis is presence of gallstones in the common bile duct (CBD). The CBD is the tube that carries bile juices from liver & gallbladder to the intestine. In almost 1 out of 7 patients with gallstones, these stones may slip into the CBD.

Stones in the CBD may present with pain in upper abdomen that may aggravate after meals, jaundice, fever, decreased appetite, nausea and vomiting.

Based on history of your symptoms and clinical examination – initial investigations are blood tests (including complete blood counts, liver function tests) and USG abdomen. If a suspicion of CBD stones is raised by these investigations reports then your doctor may ask for MRI (MRCP) of abdomen to confirm the diagnosis. However, if suspicion of CBD stones persists even though MRCP does not report CBD stones, then your doctor may advice for EUS (Endoscopic Ultrasound).

Endoscopic retrograde cholangiography (ERCP) is the treatment of choice for CBD stones. In this procedure CBD is cleared of the stones with the help of endoscopy and fluoroscopy. Frequently after clearance of the CBD a stent is placed into the bile duct to keep it patent.

Rarely in few patients where entry into the CBD is technically not feasible (large perivaterian diverticula or altered anatomy due to previous surgery) or if there is impacted large stone in CBD that cannot be removed endoscopically – surgery may be indicated ( Surgery can be performed by open, laparoscopic or robotic techniques.

CBD stones may cause complications:

Yes, after clearance of CBD by ERCP surgery for gallbladder removal must be performed as soon as possible to prevent recurrence of symptoms. Frequently laparoscopic cholecystectomy (gallbladder stones) i.e. laparoscopic removal of gallbladder is performed next day after ERCP if patient is well.