What they are
Most bile duct stones start in the gallbladder and slip down into the duct. Less often they form inside the duct itself, sometimes years after the gallbladder has been removed. Doctors call them CBD stones or choledocholithiasis.
Symptoms
- Pain in the upper-right or middle of the belly, sometimes going to the back
- Yellow eyes or skin (jaundice), dark urine, pale stools, itching
- Fever with shivering, a sign of infection called cholangitis
- Sometimes pancreatitis, if the stone blocks the pancreatic opening too
How they are diagnosed
Usually it begins with blood tests (raised bilirubin and liver enzymes) and an ultrasound. If the ultrasound isn't clear, an MRCP scan or an endoscopic ultrasound (EUS) can find even small stones. EUS is especially helpful when we want to avoid an unnecessary ERCP.
Treatment: ERCP
The standard treatment is ERCP. A flexible endoscope goes through the mouth to the duodenum, the opening of the bile duct is gently widened, and the stones are pulled out with a small balloon or basket. There's no cut on the belly.
Large or hard stones may need extra tools, such as breaking the stone with a laser or mechanical crusher, or a temporary stent to keep bile flowing until a second session.
After the stones are removed
If you still have your gallbladder, removing it (laparoscopic cholecystectomy) is usually advised, ideally within a few weeks, because new stones tend to come down again. Your surgeon and I will plan the timing together.