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Choledocholithiasis: Clinical manifestations, diagnosis, and management

Mustafa A Arain, MD
Martin L Freeman, MD
Section Editor
Douglas A Howell, MD, FASGE, FACG
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF


Choledocholithiasis refers to the presence of gallstones within the common bile duct. According to the National Health and Nutrition Examination Survey (NHANES III), over 20 million Americans are estimated to have gallbladder disease (defined as the presence of gallstones on transabdominal ultrasound or a history of cholecystectomy) [1]. Among those with gallbladder disease, the exact incidence and prevalence of choledocholithiasis are not known, but it has been estimated that 5 to 20 percent of patients have choledocholithiasis at the time of cholecystectomy, with the incidence increasing with age [2-8].

In Western countries, most cases of choledocholithiasis are secondary to the passage of gallstones from the gallbladder into the common bile duct. Primary choledocholithiasis (ie, formation of stones within the common bile duct) is less common. Primary choledocholithiasis typically occurs in the setting of bile stasis (eg, patients with cystic fibrosis), resulting in a higher propensity for intraductal stone formation. Older adults with large bile ducts and periampullary diverticular are at elevated risk for the formation of primary bile duct stones. Patients with recurrent or persistent infection involving the biliary system are also at risk, a phenomenon seen most commonly in populations from East Asia. (See "Recurrent pyogenic cholangitis".)

The causes of primary choledocholithiasis often affect the biliary tract diffusely, so patients may have both extrahepatic and intrahepatic biliary stones. Intrahepatic stones may be complicated by recurrent pyogenic cholangitis.

This topic will review the clinical manifestations and diagnosis of choledocholithiasis. The treatment of choledocholithiasis, as well as the epidemiology and the general management of patients with gallstones, are discussed separately:

(See "Endoscopic management of bile duct stones: Standard techniques and mechanical lithotripsy".)


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Literature review current through: Sep 2016. | This topic last updated: Mar 13, 2015.
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