Bile Duct Obstruction and Choledocholithiasis: When Stones or Strictures Block the Bile Duct

Bile duct obstruction happens when the flow of bile from the liver to the small intestine is blocked. It is a broad term that covers two different situations: a gallstone that has moved into the bile duct itself, known as choledocholithiasis, and a narrowing of the duct called a stricture. Both can produce similar symptoms, but they arise differently and are managed differently, so understanding which one applies to you is an important part of your care. If you have already read about biliary colic and cholecystitis, this page continues that story for the smaller number of people whose stones, or scarring, affect the bile duct itself rather than the gallbladder alone.

What is Bile Duct Obstruction?

The common bile duct is the tube that carries bile from the liver and gallbladder into the small intestine, where it helps digest fat. Anything that blocks this tube causes bile to back up, a process called cholestasis, which leads to a build-up of bilirubin in the blood and often results in jaundice, a yellowing of the skin and the whites of the eyes. The two most common causes of this kind of blockage are a gallstone lodging inside the duct and a stricture, a section of the duct that has narrowed and restricts the flow of bile even when no stone is present.

Choledocholithiasis: When a Gallstone Moves into the Bile Duct

Choledocholithiasis occurs when a gallstone leaves the gallbladder and becomes lodged in the common bile duct. Very small stones can sometimes pass through into the small intestine without causing any noticeable symptoms. Larger stones are more likely to cause a blockage, which can present as jaundice, with or without infection of the bile ducts, or sometimes only as an abnormal result on liver blood tests taken for another reason. Occasionally, a stone lodged at the lower end of the bile duct can also trigger inflammation of the pancreas, producing significant pain of its own.

Mirizzi Syndrome: A Less Common Cause

In a small number of cases, a stone becomes impacted in the neck of the gallbladder rather than travelling into the bile duct itself, and the resulting swelling presses on the duct from the outside. This is known as Mirizzi syndrome. Because the stone compresses the duct rather than sitting inside it, this condition can make surgery more complex and may require reconstruction of the bile duct.

Biliary Strictures: When the Duct itself Narrows

A biliary stricture is a section of the bile duct that has become narrowed, restricting the flow of bile even when no stone is present. Most strictures are benign and develop as a result of injury to the duct during previous gallbladder or liver surgery, though they can also occur with chronic inflammation of the pancreas or as part of Primary Sclerosing Cholangitis, a condition affecting the bile ducts themselves. Left untreated, a stricture can lead to ongoing bile build-up, jaundice and repeated infections of the bile duct, and in longstanding cases, permanent liver damage. Because a narrowing in the bile duct can, in rare cases, be caused by a tumour rather than scarring, your gastroenterologist will make sure this possibility has been carefully excluded as part of your assessment.

Symptoms of Bile Duct Obstruction

Regardless of the underlying cause, bile duct obstruction often produces jaundice, which may be the first sign that prompts investigation. Some people also experience upper abdominal pain, while others have no symptoms at all and are only found to have a blockage after an abnormal liver blood test or an imaging scan performed for another reason. If infection develops alongside the blockage, fever and worsening pain can also occur, which is a sign that urgent treatment is needed.

How is Bile Duct Obstruction Diagnosed?

An abdominal ultrasound is usually the first test, as it can identify gallstones and give an indication of the size of the bile ducts. Blood tests to check liver function are also performed, since abnormal results can point towards a stone or narrowing within the bile duct even before it is seen on imaging. Depending on the findings, further imaging such as MRCP or endoscopic ultrasound may be recommended for a more detailed look at the bile duct.

Treatment Options

Removing a Stone from the Bile Duct

Stones within the bile duct are most commonly removed using ERCP, a procedure in which a flexible telescope is passed through the mouth and stomach to reach the opening of the bile duct. A small cut is made to widen this opening, allowing the stone to be removed. If the stone is large, a temporary stent, a small tube, may be inserted to relieve jaundice while further treatment is planned. In some cases, stones are instead removed during the same operation as gallbladder removal, using a wire basket or a balloon catheter passed into the duct. ERCP is performed by a gastroenterologist, while bile duct exploration during gallbladder surgery is carried out by a surgeon, and your care team will discuss which approach best suits your situation.

Managing a Bile Duct Stricture

Endoscopic treatment is generally the first approach for a benign bile duct stricture. During ERCP, the narrowed section can be gently stretched and a stent inserted to hold the duct open while it heals. Depending on the cause and location of the stricture, this may involve a plastic stent that is exchanged periodically over several months, or in some cases a longer-acting metal stent. If endoscopic treatment is not successful, or if the stricture is more complex, referral to a specialist surgical team for reconstruction of the bile duct may be needed.

Potential Complications

Most bile duct blockages can be treated successfully, but if left untreated, both stones and strictures carry the risk of ongoing infection of the bile ducts, persistent jaundice and, in longstanding cases, damage to the liver itself. Procedures used to clear the duct, such as ERCP or bile duct exploration, also carry their own small risks, including bleeding, a leak of bile, inflammation of the pancreas, or, occasionally, a stone or narrowing that returns and needs further treatment. Where a stent has been placed, there is also a small chance it can shift out of position over time. Your gastroenterologist will discuss the risks relevant to your specific procedure before you go ahead.

Recovery and Follow-Up

Recovery depends on the treatment required. If your bile duct is explored at the same time as gallbladder removal, recovery generally follows the same course as a standard cholecystectomy: most people go home within one to two days after keyhole surgery, or four to five days after open surgery, and return to work within three to four weeks. ERCP performed on its own is usually a shorter procedure with a quicker return home. If a stent has been placed for a stricture, treatment is not usually a one-off event, further procedures are often needed every few months to exchange or remove the stent as the duct heals. Regular follow-up with your gastroenterologist allows this progress to be monitored and your treatment plan adjusted as needed.

When to Seek Urgent Care

Jaundice combined with fever and worsening abdominal pain can indicate that an infection has developed in the bile ducts, which needs urgent treatment. If you experience these symptoms together, seek urgent medical attention at your nearest hospital emergency department rather than waiting for a routine appointment.

When to See a Gastroenterologist

If you have been told you have gallstones, jaundice, or an abnormal liver blood test, speak with your GP about a referral to Queensland Gastroenterology. Our specialists can arrange further imaging and, where needed, ERCP to investigate and treat blockages of the bile duct. Our team work alongside your GP and, where surgery is required, your surgical team, to coordinate the most appropriate care for your situation.

References

This information has been adapted from the following sources, as at 6/8/2026. It is intended for general patient education and does not replace individual medical advice from your GP or gastroenterologist.

Healthdirect Australia. Cholecystectomy and exploration of the bile duct. Last reviewed January 2026.

Gastroenterological Society of Australia (GESA). Gallstones [patient information factsheet]. Reviewed 2021.

Crawford M. Biliary pain: work-up and management in general practice. Australian Family Physician. 2013;42(6):458–461.

Wong MYW, Saxena P, Kaffes AJ. Benign Biliary Strictures: A Systematic Review on Endoscopic Treatment Options. Diagnostics. 2020;10(4):221.