Common Bile Duct Stones

Overview

This problem refers to the presence of stones within the common bile duct. These stones usually come from the gallbladder. It is therefore considered a complication of gallstones. Rarely are the stones formed in the bile duct itself.

Symptoms

The most common symptom is pain. This is due to the stone causing blockage of the bile duct. Along with the pain, because of the blockage of the bile duct, the bile cannot flow into the small intestine. This then results in jaundice, and injury to the liver. There will be a yellow discoloration of the person’s eye. This person will also notice the urine to be dark-coloured (or tea-colored), and the stools to be pale in colour. When the bile duct is blocked, it becomes prone to infection. Such infection can be life-threatening. The person will experience high fever, along with chills and shivering. This condition is called cholangitis. Any stone in the bile duct can also cause injury and inflammation to the pancreas. This condition is called pancreatitis. It can also lead to death if the pancreas inflammation is severe.

When to Seek Treatment

The person with bile duct stones will usually present as an emergency, due to the sudden or intense abdominal pain. This person will either seek urgent help at his family doctor or at an Accident & Emergency Department.

Sometimes, the bile duct stones do not cause symptoms. Such cases are only detected when the person goes for a check-up and finds some abnormalities in the liver function test. Because of the abnormal readings, the doctor will usually ask for some form of liver scan.

Diagnosis

The diagnosis is usually confirmed by a scan of the bile duct. The ultrasound may report a dilated bile duct with some shadows within it. A more accurate scan to look at the bile duct will be the MRCP. Supporting evidence will be abnormalities in the liver function test.

Treatment

Unlike the situation with gallbladder stones where surgery is recommended only when a person has symptoms, for stones in the common bile duct, treatment is highly recommended even if the person claims he has no symptoms. This is because of the potential dire consequences of common bile duct stones.

There are 2 main options for the removal of common bile duct stones.

1. Laparoscopic Common Bile Duct Exploration (LCBDE)

LCBDE is one of the techniques to surgically remove common bile duct stones. The gallbladder is usually removed at the same time, since most of the bile duct stones originate from the gallbladder. It is a surgical operation performed through small incisions. Typically, 4 small incisions are needed.

2. ERCP Followed by Laparoscopic Cholecystectomy

ERCP is a special endoscopic procedure which allows the doctor to remove bile duct stones. In this method, there are 2 steps to it

Step 1

The patient will have to undergo an endoscopy called an ERCP, during which the endoscopist will widen the bile duct opening in the small intestine (sphincterotomy). The endoscopist will then attempt to remove the stone in the bile duct.

Step 2

If step 1 is successful, the patient then proceeds to step 2 to remove the gallbladder. This is usually done by the keyhole technique called the laparoscopic cholecystectomy.

Step 1 and 2 are usually performed on different days. Hence, the disadvantages of this method of treating bile duct stones are

– 2 separate procedures, each with its own risks

– 2 separate days, hence the treatment period may be prolonged.

Causes

Most bile duct stones originate from the gallbladder. Gallstones are very common. Gallstones can pass from the gallbladder into the bile duct. This is because the gallbladder, being a muscular bag, can squeeze the gallstone within it into the bile duct when it contracts. This will usually trigger a painful attack called biliary colic.

Stones can also form in the bile duct itself, but this is uncommon.

Risk Factors

​​Less than 10% of bile duct stones are formed in the bile duct itself. Some of the risk factors for stones forming in the bile duct are:

  • Recurrent infection of the bile duct. This may be precipitated by parasite infection of the bile duct, seen in certain under-developed countries where the water hygiene is an issue
  • Congenital abnormalities of the bile duct such as choledochal cyst
  • Scarring in the bile duct due to previous operations or ERCP

Consult Our Doctors

Dr Ho Choon Kiat
Senior Consultant HepatoBiliary, Pancreas & General Surgeon

MBBS (Singapore), FRCS (Edin), FRCS (Glasg), M.Med (Surgery), FRCSEd (Gen), FAMS (Surgery) Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine

Dr Chan Chung Yip
HepatoBiliary, Pancreas & General Surgeon

MBBS, MMed(Surg), FRCS(Edin), MD, FAMS

Consult Our Doctor

Dr Ho Choon Kiat
Senior Consultant HepatoBiliary, Pancreas & General Surgeon

MBBS (Singapore), FRCS (Edin), FRCS (Glasg), M.Med (Surgery), FRCSEd (Gen), FAMS (Surgery) Adjunct Assistant Professor, NUS Yong Loo Lin School of Medicine

FAQs

Avoiding standing still for long periods will reduce the pressure in the veins in the legs. For people who need to stand for long periods at work, wearing compression stockings will reduce the pressure build up in the legs.

The ultrasound will be done of the legs from the thigh to the calves. Please wear or bring along a pair of shorts to change into for the scan.

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