Common Bile Duct Stones

The gallbladder sits beneath the liver and stores the bile (a digestive agent) that the liver secretes until it’s needed in the intestines. Bile helps absorb the fats in what we consume, and it carries toxins and other waste from the liver that cannot pass through the kidneys.

The bile travels through a series of ducts, or small tubes, that attach the gallbladder to the liver and to the intestines. Sometimes, substances in the bile, such as cholesterol and bilirubin, may crystalize and form into small pebbles that can block these ducts. These are commonly called stones.

Gallstones can be as tiny as a grain of sand or as large as golf balls, and a person can develop one to hundreds of them. Nearly 1 million people are diagnosed with gallstones a year.

Sometimes gallstones can be symptomatic. Common symptoms can include:

  • Pain in the upper abdomen (often occurs after eating)
  • Pain in the right shoulder or back
  • Nausea and vomiting
  • Gas or indigestion

The following signs may indicate inflammation or infection and require more urgent evaluation:

  • Abdominal pain that lasts hours
  • Low-grade fever
  • A yellowing of the eye and skin (jaundice)
  • Darkened urine and/or light-colored stool
After a physical exam, your doctor may order a routine liver blood test, which can detect if bile has backed up into the liver. Different blood exams can check for signs of infection of blockage.

Other tests include:

  • Abdominal ultrasound –This tool sends sound waves that bounce against hard objects, such as stones.
  • Endoscopic ultrasound This test combines an ultrasound with an endoscopy.
  • Computerized tomography (CT) scan or MRI (magnetic resonance imaging) – These are specialized imaging exams.
  • Cholescintigraphy (HIDA scan) – A harmless dose of radioactive material is injected into the vein and carried to the liver, where it should be excreted. This helps determine if the gallbladder duct is blocked and if the organ squeezes correctly.

If stones are causing an attack or other symptoms, the most common course is for a surgeon to remove the gallbladder. People can still digest food without the organ.

The most common procedures are:

  • Laparoscopic cholecystectomy – The surgeon inserts a narrow tube into the abdomen through a small incision. The tube uses an attached light, camera, and surgical instruments to remove the gallbladder through another small cut. Most patients can return home within a day. This is the most common treatment.
  • Open cholecystectomy – If the gallbladder is severely inflamed or infected, it will be removed through larger cuts, requiring a few days in the hospital.
  • Endoscopic retrograde cholangiopancreatography (ERCP) – If stones are blocking the ducts, a gastroenterologist will typically remove them before surgery within this procedure, if a blockage is diagnosed in the duct, the doctor feeds a thin tube with a tiny camera, called an endoscope, through the patient’s mouth down to the small intestine, where the bile duct drains. The endoscope injects dye into the bile duct so it can be examined on x-rays. A small cut is typically made at the opening and the stone is removed.

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