Choledocholithiasis – Bile Duct Stones
Stones within the bile duct are not a problem if they’re just passing through. However, if they get stuck there, a serious condition could result.
Statistics:
- 15% of people who form gallstones are subject to having stones within the bile duct.
- 21% of gallbladder surgeries also have bile duct stones at the time of surgery.
- 20% of the general population is also prone to having bile duct stones.
- 50% of them are asymptomatic.
The most usual place for bile duct stones to be found is within the common bile duct or CBD. Sometimes the stones are not passing through but actually form there, which is why people who have had their gallbladder removed can still end up with gallstones – just not in the gallbladder.
Because research shows that 21% of people have concomitant bile duct stones at the time of their gallbladder removal, I always recommend a series of coffee enemas following recovery from surgery, just to flush out any stones or gravel that may already be in the ducts. Since the coffee stimulates a surge of bile from the liver, this should flush all the smaller hepatic (liver) ducts as well as the larger liver ducts and the largest common bile duct.
Symptoms of bile duct stones can be any of the following:
- Pain in the upper right side of the abdomen (possibly radiating into the right shoulder)
- Light colored stools
- Dark urine
- Nausea
- Vomiting
- Yellowing or jaundice
- Fever
- Loss of appetite
With choledocholithiasis or bile duct stones, 50% will have no symptoms accompanying them. So why is this something to worry about? You may have had stones in the gallbladder for years.
What’s the big deal about a stone in the duct?
Well, for starters, when a stone is large enough to block the duct, this becomes an obstruction and when bile has nowhere to go – it backs up. This is where the yellowing of eyes and skin comes from – a back up of bile. This is serious and needs immediately medical attention.
Bile stasis may result in infected bile and cause ascending cholangitis (bile duct inflammation).The obstruction of the flow of bile and pancreatic fluids into the small intestine may also cause acute pancreatitis.
Symptoms of Acute Cholangitis or Bile Duct Inflammation/Infection
- Biliary colic (or gallbladder pain)
- Jaundice
- Very high fever (106.7°F or 41.5 °C) – a sign of sepsis
- Chills
If your doctor suspects you have stones in the bile duct, he may perform any of the following tests to confirm:
Bile Duct Stones Diagnosis:
- Ultrasound
- CT scan
- ERCP exploration through tubes
- MRCP – a special MRI for gallbladder and bile ducts, liver and pancreas
- Blood work – especially pancreatic and liver enzymes
- Symptoms will also be considered
Bile Duct Stones Treatment:
Due to the potential danger of bile duct stones, natural remedies are not recommended (unless simply used for symptomatic relief while pursuing medical intervention).
- Stone retrieval or BES (Bilary Endoscopic Sphincterotomy)
- ESWL or lithotripsy – shock wave treatment to break up the stone/s
- Gallbladder removal
- Surgery to cut into the duct and remove the stone
- Bile duct stents or tubes to open the passage for bile flow
The method used will vary according to your particular situation – stone size, placement, etc. Do your own research; ask your doctor questions before deciding on the best treatment plan.
Prognosis:
What is the usual outcome following bile duct stone removal? 4 to 24% of patients will experience bile duct stones again with 15 years. You can be sure these statistics were not of people who were dedicated to changing their diet and lifestyle. Much can be done to prevent stone formation. The causes of gallstone formation are the same, within or without gallbladder. Study your risk factors and make the appropriate changes to avoid a recurrence in the future.
