One of the more common hepatobiliary disorders is common bile duct stones. This condition is characterized by obstruction of the bile duct caused by stones lodged in the common bile duct, leading to a variety of symptoms in affected patients.
What is common bile duct stones?
Common bile duct stones (choledocholithiasis) refer to the presence of stones within the bile duct, which carries bile from the liver and gallbladder to the duodenum.
Based on composition, common bile duct stones can be classified into two main types:
Cholesterol stones
Pigment stones
The number and size of the stones vary from person to person. In addition to stones in the bile duct, patients may also have stones in other locations such as the gallbladder or intrahepatic bile ducts.
Symptoms of common bile duct stones
The typical clinical manifestations of common bile duct stones include right upper quadrant abdominal pain, fever, and jaundice.
Right upper quadrant pain
Pain typically occurs 1–2 hours after meals but may arise at any time of the day. The intensity and duration of the pain progressively increase, often radiating to the chest or back, and may last 2–3 hours. This pain is usually caused by the movement of stones, increased contraction of the bile duct, heightened gallbladder motility, and elevated intrabiliary pressure.
Fever
Fever develops as a result of bacterial overgrowth due to bile stasis. Bacteria release endotoxins, leading to high fever of 39–40°C accompanied by chills and profuse sweating. High-grade fever often appears 2–3 hours after episodes of biliary colic.
Jaundice
Jaundice occurs when bile flow is obstructed and accumulates in the liver. Bilirubin from bile enters the bloodstream, causing yellow discoloration of the skin and sclera.
In addition to these classic symptoms, patients with common bile duct stones may also experience nausea, vomiting, pruritus, dark urine, and pale-colored stools.
Causes of common bile duct stones
There are multiple factors that contribute to the development of common bile duct stones. The most common causes include:
Infection and parasitic infestation When bile flow is obstructed, bacterial growth damages the bile duct wall, causing inflammation and sloughing of cells into the bile. This process promotes the precipitation of bile components such as bile pigments and bile salts, eventually leading to stone formation within the duct. In some cases, parasites such as roundworms can migrate into the bile duct, carrying eggs or dead bodies that serve as a nidus for bile pigment deposition, gradually forming stones.
Migration of stones from the intrahepatic bile ducts or gallbladder Many cases of common bile duct stones result from stones originating in the intrahepatic bile ducts or gallbladder that migrate or drop into the common bile duct.
Stones migrating from the gallbladder into the common bile duct
Risk factors for common bile duct stones
The likelihood of developing common bile duct stones is higher in individuals with a history of gallstones, gallbladder disease, and even in those who have undergone cholecystectomy. The following factors are known to increase the risk of common bile duct stone formation:
Obesity
Low-fiber, high-calorie, high-fat diet
Pregnancy
Prolonged vegetarian diet
Rapid weight loss within a short period of time
Sedentary lifestyle or limited physical activity
In addition, there are non-modifiable risk factors, including:
Age: older adults are at higher risk of developing gallstones and bile duct stones.
Gender: women are more likely to develop gallstones.
Family history: individuals with relatives affected by common bile duct stones have a higher likelihood of developing the condition.
Complications of common bile duct stones
If left untreated, common bile duct stones may lead to a number of serious complications.
Acute complications of common bile duct stones
Biliary peritonitis due to bile leakage Obstruction of the common bile duct leads to bile stasis, with bile seeping through the duct wall into the peritoneal cavity.
Biliary peritonitis due to perforation Bile and bacteria spill into the peritoneal cavity as a result of gallbladder rupture or bile duct perforation, causing peritoneal infection.
Suppurative cholangitis and hepatic abscesses Suppurative cholangitis arises from bile stasis combined with infection. The bile becomes turbid, dark, foul-smelling, and mixed with pus. This condition can progress to multiple small liver abscesses, presenting with high fever, chills, hepatomegaly, and right upper quadrant pain.
Hemobilia (bleeding into the biliary tract) Ulceration of the bile duct wall due to stones and abscesses may create a fistula between the bile duct and intrahepatic blood vessels. Clinical signs include hematemesis or melena. The bleeding is often persistent, recurrent, and difficult to control.
Acute pancreatitis due to bile duct stones Stones lodged in the distal common bile duct or impacted at the sphincter of Oddi can trigger acute pancreatitis. On examination, patients may present with flank tenderness, while blood and urine amylase levels are markedly elevated.
Acute renal failure secondary to biliary obstruction (hepatorenal syndrome) Manifestations include oliguria or anuria, progressive jaundice, and elevated blood urea and creatinine levels. This is a severe complication that may be life-threatening.
Septic shock due to ascending cholangitis Patients present with obstructive jaundice, fluctuating high fever, tachycardia exceeding 120 beats per minute, hypotension, and positive blood cultures—most commonly showing gram-negative bacteria. This complication carries a high mortality rate.
Chronic complications of common bile duct stones
Chronic cholangitis
Chronic pancreatitis
Secondary biliary cirrhosis
Cholangitis is a serious complication of common bile duct stones.
Diagnostic methods for common bile duct stones
If the frequency and severity of symptoms increase, patients should seek medical attention promptly. At the hospital, a range of diagnostic tests may be performed to confirm the condition and determine the most appropriate and timely treatment approach.
Blood biochemical tests
Urine tests
Abdominal and biliary X-ray imaging
Endoscopic ultrasound (EUS)
Magnetic resonance cholangiopancreatography (MRCP)
CT scan
Treatment methods for common bile duct stones
Medical treatment
Nasobiliary drainage
Intravenous fluid and electrolyte replacement
Antibiotics against gram-negative and anaerobic bacteria
Pain relief
Vitamin K and fresh frozen plasma in case of coagulation disorders
Surgical treatment
The principle of managing bile duct stones is to completely remove the stones and ensure adequate biliary drainage. The treatment options include:
Other biliary drainage procedures such as sphincteroplasty or choledochoduodenostomy
Among these, endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic technique that has been proven highly effective and is widely applied in medically developed countries such as the United States and Japan. However, ERCP is a highly specialized procedure that requires experienced physicians and state-of-the-art equipment. In Vietnam, only a limited number of hospitals are capable of performing this technique, including Hong Ngoc General Hospital.
Associate Professor, PhD, MD Nguyen Canh Binh – Head of the Department of Gastroenterology, Hong Ngoc General Hospital – is one of the country’s leading experts in gastrointestinal endoscopy, particularly in complex procedures such as endoscopic retrograde cholangiopancreatography (ERCP). With more than 35 years of professional experience and advanced training both in Vietnam and abroad, Dr. Nguyen Canh Binh has successfully performed thousands of difficult interventions, helping patients with bile duct obstruction avoid major and complicated surgeries.
Placement of a biliary stent to drain 70% of the bile duct in a 68-year-old patient who was in critical condition with poor general health due to prolonged high fever.
Successful removal of cast-like stones and common bile duct stones in a 52-year-old patient with a history of four previous open surgeries, helping the patient avoid another major operation.
Successful removal of four large stones from the common bile duct in a 77-year-old French patient with multiple comorbidities, including severe acute pancreatitis, type 2 diabetes, hypertension, coronary artery disease, thyroid disorder, and obstructive sleep apnea.
And hundreds of other patients with common bile duct stones, cholangitis, and biliary obstruction who have been treated successfully.
Assoc. Prof. Dr. Nguyen Canh Binh – a gastroenterology specialist with over 35 years of experience – and his team performed ERCP to remove common bile duct stones and drain the biliary tract.
Prevention of common bile duct stones
Common bile duct stones may recur even after surgery. Therefore, the following measures are recommended to help prevent stone formation:
Limit the intake of saturated fats and replace them with healthy sources of fat.
Eat a diet rich in fiber and fruits high in vitamin C, while reducing refined sugars and starches.
Drink plenty of water.
Limit the consumption of alcohol and coffee.
Exercise and stay physically active on a regular basis.
Avoid rapid weight loss; instead, aim for gradual and sustainable weight reduction.
Maintain a healthy weight and prevent obesity.
Do not skip meals, especially breakfast.
Note: The information in this article by Hong Ngoc General Hospital is for reference purposes only and does not replace professional medical diagnosis or treatment. Patients should not self-medicate. To determine the exact condition, it is essential to visit the hospital for direct examination, diagnosis, and treatment planning by qualified doctors.
Gastroenterology Center – Hong Ngoc General Hospital
Hong Ngoc Phuc Truong Minh General Hospital – No. 8 Chau Van Liem, Nam Tu Liem District, Hanoi
Hong Ngoc General Hospital – 55 Yen Ninh, Ba Dinh District, Hanoi
Hong Ngoc Tasco Long Bien Clinic – 3rd Floor, Tower B, Tasco Megamall, 07–09 Nguyen Van Linh, Long Bien District, Hanoi
One of the more common hepatobiliary disorders is common bile duct stones. This condition is characterized by obstruction of the bile duct caused by stones lodged in the common bile duct, leading to a variety of symptoms in affected patients.
What is common bile duct stones?
Common bile duct stones (choledocholithiasis) refer to the presence of stones within the bile duct, which carries bile from the liver and gallbladder to the duodenum.
Based on composition, common bile duct stones can be classified into two main types:
Cholesterol stones
Pigment stones
The number and size of the stones vary from person to person. In addition to stones in the bile duct, patients may also have stones in other locations such as the gallbladder or intrahepatic bile ducts.
Symptoms of common bile duct stones
The typical clinical manifestations of common bile duct stones include right upper quadrant abdominal pain, fever, and jaundice.
Right upper quadrant pain
Pain typically occurs 1–2 hours after meals but may arise at any time of the day. The intensity and duration of the pain progressively increase, often radiating to the chest or back, and may last 2–3 hours. This pain is usually caused by the movement of stones, increased contraction of the bile duct, heightened gallbladder motility, and elevated intrabiliary pressure.
Fever
Fever develops as a result of bacterial overgrowth due to bile stasis. Bacteria release endotoxins, leading to high fever of 39–40°C accompanied by chills and profuse sweating. High-grade fever often appears 2–3 hours after episodes of biliary colic.
Jaundice
Jaundice occurs when bile flow is obstructed and accumulates in the liver. Bilirubin from bile enters the bloodstream, causing yellow discoloration of the skin and sclera.
In addition to these classic symptoms, patients with common bile duct stones may also experience nausea, vomiting, pruritus, dark urine, and pale-colored stools.
Causes of common bile duct stones
There are multiple factors that contribute to the development of common bile duct stones. The most common causes include:
Infection and parasitic infestation When bile flow is obstructed, bacterial growth damages the bile duct wall, causing inflammation and sloughing of cells into the bile. This process promotes the precipitation of bile components such as bile pigments and bile salts, eventually leading to stone formation within the duct. In some cases, parasites such as roundworms can migrate into the bile duct, carrying eggs or dead bodies that serve as a nidus for bile pigment deposition, gradually forming stones.
Migration of stones from the intrahepatic bile ducts or gallbladder Many cases of common bile duct stones result from stones originating in the intrahepatic bile ducts or gallbladder that migrate or drop into the common bile duct.
Stones migrating from the gallbladder into the common bile duct
Risk factors for common bile duct stones
The likelihood of developing common bile duct stones is higher in individuals with a history of gallstones, gallbladder disease, and even in those who have undergone cholecystectomy. The following factors are known to increase the risk of common bile duct stone formation:
Obesity
Low-fiber, high-calorie, high-fat diet
Pregnancy
Prolonged vegetarian diet
Rapid weight loss within a short period of time
Sedentary lifestyle or limited physical activity
In addition, there are non-modifiable risk factors, including:
Age: older adults are at higher risk of developing gallstones and bile duct stones.
Gender: women are more likely to develop gallstones.
Family history: individuals with relatives affected by common bile duct stones have a higher likelihood of developing the condition.
Complications of common bile duct stones
If left untreated, common bile duct stones may lead to a number of serious complications.
Acute complications of common bile duct stones
Biliary peritonitis due to bile leakage Obstruction of the common bile duct leads to bile stasis, with bile seeping through the duct wall into the peritoneal cavity.
Biliary peritonitis due to perforation Bile and bacteria spill into the peritoneal cavity as a result of gallbladder rupture or bile duct perforation, causing peritoneal infection.
Suppurative cholangitis and hepatic abscesses Suppurative cholangitis arises from bile stasis combined with infection. The bile becomes turbid, dark, foul-smelling, and mixed with pus. This condition can progress to multiple small liver abscesses, presenting with high fever, chills, hepatomegaly, and right upper quadrant pain.
Hemobilia (bleeding into the biliary tract) Ulceration of the bile duct wall due to stones and abscesses may create a fistula between the bile duct and intrahepatic blood vessels. Clinical signs include hematemesis or melena. The bleeding is often persistent, recurrent, and difficult to control.
Acute pancreatitis due to bile duct stones Stones lodged in the distal common bile duct or impacted at the sphincter of Oddi can trigger acute pancreatitis. On examination, patients may present with flank tenderness, while blood and urine amylase levels are markedly elevated.
Acute renal failure secondary to biliary obstruction (hepatorenal syndrome) Manifestations include oliguria or anuria, progressive jaundice, and elevated blood urea and creatinine levels. This is a severe complication that may be life-threatening.
Septic shock due to ascending cholangitis Patients present with obstructive jaundice, fluctuating high fever, tachycardia exceeding 120 beats per minute, hypotension, and positive blood cultures—most commonly showing gram-negative bacteria. This complication carries a high mortality rate.
Chronic complications of common bile duct stones
Chronic cholangitis
Chronic pancreatitis
Secondary biliary cirrhosis
Cholangitis is a serious complication of common bile duct stones.
Diagnostic methods for common bile duct stones
If the frequency and severity of symptoms increase, patients should seek medical attention promptly. At the hospital, a range of diagnostic tests may be performed to confirm the condition and determine the most appropriate and timely treatment approach.
Blood biochemical tests
Urine tests
Abdominal and biliary X-ray imaging
Endoscopic ultrasound (EUS)
Magnetic resonance cholangiopancreatography (MRCP)
CT scan
Treatment methods for common bile duct stones
Medical treatment
Nasobiliary drainage
Intravenous fluid and electrolyte replacement
Antibiotics against gram-negative and anaerobic bacteria
Pain relief
Vitamin K and fresh frozen plasma in case of coagulation disorders
Surgical treatment
The principle of managing bile duct stones is to completely remove the stones and ensure adequate biliary drainage. The treatment options include:
Other biliary drainage procedures such as sphincteroplasty or choledochoduodenostomy
Among these, endoscopic retrograde cholangiopancreatography (ERCP) is an advanced endoscopic technique that has been proven highly effective and is widely applied in medically developed countries such as the United States and Japan. However, ERCP is a highly specialized procedure that requires experienced physicians and state-of-the-art equipment. In Vietnam, only a limited number of hospitals are capable of performing this technique, including Hong Ngoc General Hospital.
Associate Professor, PhD, MD Nguyen Canh Binh – Head of the Department of Gastroenterology, Hong Ngoc General Hospital – is one of the country’s leading experts in gastrointestinal endoscopy, particularly in complex procedures such as endoscopic retrograde cholangiopancreatography (ERCP). With more than 35 years of professional experience and advanced training both in Vietnam and abroad, Dr. Nguyen Canh Binh has successfully performed thousands of difficult interventions, helping patients with bile duct obstruction avoid major and complicated surgeries.
Placement of a biliary stent to drain 70% of the bile duct in a 68-year-old patient who was in critical condition with poor general health due to prolonged high fever.
Successful removal of cast-like stones and common bile duct stones in a 52-year-old patient with a history of four previous open surgeries, helping the patient avoid another major operation.
Successful removal of four large stones from the common bile duct in a 77-year-old French patient with multiple comorbidities, including severe acute pancreatitis, type 2 diabetes, hypertension, coronary artery disease, thyroid disorder, and obstructive sleep apnea.
And hundreds of other patients with common bile duct stones, cholangitis, and biliary obstruction who have been treated successfully.
Assoc. Prof. Dr. Nguyen Canh Binh – a gastroenterology specialist with over 35 years of experience – and his team performed ERCP to remove common bile duct stones and drain the biliary tract.
Prevention of common bile duct stones
Common bile duct stones may recur even after surgery. Therefore, the following measures are recommended to help prevent stone formation:
Limit the intake of saturated fats and replace them with healthy sources of fat.
Eat a diet rich in fiber and fruits high in vitamin C, while reducing refined sugars and starches.
Drink plenty of water.
Limit the consumption of alcohol and coffee.
Exercise and stay physically active on a regular basis.
Avoid rapid weight loss; instead, aim for gradual and sustainable weight reduction.
Maintain a healthy weight and prevent obesity.
Do not skip meals, especially breakfast.
Note: The information in this article by Hong Ngoc General Hospital is for reference purposes only and does not replace professional medical diagnosis or treatment. Patients should not self-medicate. To determine the exact condition, it is essential to visit the hospital for direct examination, diagnosis, and treatment planning by qualified doctors.
Gastroenterology Center – Hong Ngoc General Hospital
Hong Ngoc Phuc Truong Minh General Hospital – No. 8 Chau Van Liem, Nam Tu Liem District, Hanoi
Hong Ngoc General Hospital – 55 Yen Ninh, Ba Dinh District, Hanoi
Hong Ngoc Tasco Long Bien Clinic – 3rd Floor, Tower B, Tasco Megamall, 07–09 Nguyen Van Linh, Long Bien District, Hanoi
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