Common Duct Stones

What are common duct stones?

Common duct stones are stones that have lodged in the common bile duct. The common bile duct carries bile from the liver and gallbladder to the small intestine. (Bile helps your body digest fats.) The stones are gravel-like deposits that form from cholesterol or other substances in bile. Small stones can leave the gallbladder through a small duct that empties into the common duct.

The gallbladder is a small sac that lies under the liver on your right side. It is part of the digestive system. It stores the bile made by the liver.

How do they occur?

Most gallstones and duct stones are made of cholesterol in the bile. Usually acids in bile keep cholesterol from forming into stones. If the amount of cholesterol in the bile increases beyond the ability of acids to keep a balance, the cholesterol crystallizes and forms a stone. Some common duct stones result from infection in the bile duct or liver.

Stones usually form in the gallbladder, but they may form in the common bile duct. When stones form in the common bile duct or move from the gallbladder into the common bile duct and become lodged in the duct, the condition is called choledocholithiasis.

Pressure from stones blocking the duct makes it hard for the liver and gallbladder to work normally. As a result, if you have stones in the bile ducts, you may have sudden pain on the right side of your abdomen and you may notice that your skin looks yellow.

Common duct stones happen more often in people who are obese, have diabetes, or are taking drugs to lower cholesterol.

What are the symptoms?

The symptoms of common duct stones include:

• severe attacks of pain in the upper right part of the abdomen, which can last for hours
• jaundice, which is a yellowing of the skin and whites of the eyes caused by too much bile pigment (bilirubin) in the blood
• light colored bowel movements and dark urine
• chills and fever
• nausea and vomiting.

How are they diagnosed?

Your healthcare provider will ask about your symptoms and do a physical exam.

He or she may order lab tests to look for signs of bile duct blockage. In addition, these tests may be performed:

• ultrasound scan
• CT (computerized tomography) scan
• nuclear gallbladder scan (called a HIDA or DISIDA scan)
• cholangiogram, which is an exam of the bile ducts with X-rays and dye
• endoscopic retrograde cholangiopancreatography (ERCP), which is an exam with an endoscope, a slim, lighted tube that can be passed through the stomach and into the small intestine.

How are they treated?

Possible treatments are ERCP and surgery.

When ERCP is done to treat common duct stones, the endoscope can be used to enlarge the opening from the common bile duct into the intestine. It may then be possible to remove the stones or allow them to pass through the enlarged opening.

The stones may be surgically removed. After one or more stones are removed from the common bile duct, the surgeon will remove the gallbladder and open the common bile duct to make sure that all stones are removed. If there is any question that stones may still be in the common bile duct, the surgeon will put a tube called a T-tube in the common duct. The T-tube is used to explore and drain the common duct. A cholangiogram (a special X-ray using dye) can be done through the T-tube. If more stones are seen, they are removed. The tube may be left in place and another X-ray may be done 7 or 8 days after surgery. If more stones are then found, a radiologist can remove the stones. If no stones are seen with the cholangiogram and bile is flowing properly, the T-tube may be clamped overnight and removed the next day. However, your surgeon may decide to keep the T-tube in longer.

During surgery a sample of your bile will be checked for infection in the biliary tract. If you have an infection, you may be given an antibiotic after the operation.

How long will the effects last?

The effects of this condition will last as long as there are stones in the bile duct and cause problems in the liver and gallbladder.

How can I take care of myself?

• Call your healthcare provider if your temperature is over 100°F (37.8°C) or you have chills. Ask your provider if you can take aspirin, acetaminophen, or ibuprofen to control your fever. Keep a daily record of your temperature.
• If you are chilled, stay warm but do not cover up so much that you sweat.
• If you have had surgery, limit strenuous activity according to your provider's instructions.
• If your symptoms continue or if you develop new symptoms, tell your provider.