The presence of stones in the bile ducts (choledocholithiasis) is most often a consequence of the migration of stones from the gallbladder into the downstream bile ducts. The formation of stones in the bile ducts themselves is much more rare, but can occur during specific events (biliary stagnation, infection, etc.).
People with stones in the bile ducts may experience pain under the ribs on the right side, nausea and vomiting, but also have no symptoms. Some of the patients develop jaundice .
Looking for bile duct stones
Elevation of liver enzymes in the blood may suggest that stones are preventing bile from draining. The diagnosis of bile duct stones is therefore made on the basis of blood tests, combined with internal ultrasound (endoscopy) or external ultrasound (to visualize the stones and a possible dilation of the bile ducts), by CT scan or by dedicated MRI.
Treatment of bile duct stones
The treatment of bile duct stones is based on emergency cholecystectomy and the injection of X-ray product into the bile ducts to check for the presence or absence of stones (sometimes, the stones continue to move into the intestine). If the examination reveals one or more residual stones, the surgical procedure is completed in a second step by an endoscopy . During this procedure performed by gastroenterologists, a sphincterotomy is performed. It involves making a small incision to widen the sphincter of Oddi, a valve that regulates the flow of bile and pancreatic fluids through the duodenum , allowing stones to pass downwards.
In rare cases, surgical exploration of the bile ducts is necessary.
Possible complications of bile duct stones
Possible complications due to the presence of stones in the bile ducts are acute cholangitis or biliary pancreatitis .
In case of acute cholangitis, the management is identical to the one described for bile duct stones, but also includes the administration of antibiotics. Rare cases may require emergency drainage of the bile ducts by placing drains through the skin into the bile ducts, performed by the interventional radiology team, before further management.