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“Common bile duct is dilated”

Posted On : March 10, 2011  
Common Bile duct is part of the “plumbing” that drains the secretion of the liver (bile) into small bowel (duodenum).  The size of the common bile duct, if dilated, may suggest a blockage downstream. This is a specific finding that is looked for when a patient gets an ultrasound for a suspected liver or Gallbladder disease. When a patient has their gallbladder removed, the common bile duct dilates over some time. Dilated common bile after a cholecystectomy is of no significance by itself and should only be considered important if there are other findings, such as pancreatitis or elevated liver function tests.It is, however, important to remember that for any patient who has had the Duodenal switch operation, or the Gastric bypass procedure, the altered anatomy precludes the option of MRCP as a diagnostic or Therapeutic study.
I have loaded a new MRCP study. Ara, Keshishian, MD, FACS, FASMBS

126 responses to ““Common bile duct is dilated””

  1. I had gallbladder removed in 1982. In 2011, I started throwing up & kept throwing up, went from 127 to 96. Finslky got a good dr, who said I had dilated bile duct & also 14cm cyst on right kidney. Nothing cld be done until cyst was drained. Had that drained in Aug & kept throwimg up. High liver function trsts & low potassium, low calcium(malnurished). Had ERCP in Oct. Got better but still no appetite. Gotta hv cyst removed, since it is growing back. Am scared to eat. Is that normal? Will bilecduct dilate again? What happenrd?

  2. Hello,
    I am not sure if I know of any connection between the Gallbladder surgery in 82, and the Kidney cyst. Dilated common bile duct however is common after gallbladder surgery, and this by itself, may result in gallstone formation in the bile duct, (knows as primary biliary stones).
    There are a number of surgical treatment for a primary biliary stone.
    Thank you

  3. Hello,
    It appears that your Ejection Fraction (EF) was 9%. The common practice is that patients with no evidence of gallstone, and symptoms of gallbladder (GB) attacks, are evaluated and if the EF is less that 30% then it is removed. This is where the information may get confusing. There is some data that suggests that not in all cases the symptoms resolved after GP is removed. This may be your case. There may be other causes that may mimic your symptoms. May be related to ducts of the GB and the pancreas and anatomical variations.

    Biliary track dilatation is commonly seen after GB removal.Unless you have Gallstones formed in the biliary tree after your GB surgery (this is known and primary biliary stones) then I do not think that your symptoms are results of the dilated ducts.
    Thank you

    • Hello I am 41 I had my gallbladder removed as well as growing fnh of liver left lobe 5 months ago I have been having severe upper abdominal pain that when it comes on it’s hard to talk it radiates to my back and then erased up and goes away it’s happened 5 times now in 1 month I’ve had an mrcp and my bile duct is dilaleted 12 mm and malrotation of small intestine. The liver surgeon said that that is all normal and doesn’t want to do ercp. My gastro is concerned that there is a bile duct issue I’m worried this pain is scary and never had it before surgery. What do I do

        • They did an recap and found no abnormalities they suspect sphincter of odi I recently happened again 3 months later and this time I had diarrhea I was nauseous lightheaded when the pain came on it was so severe bile duct is now dilated 14 mm not sure what to do they say maybe Ecco but that I could get pancreatitis. Witch could be deadly so do I just deal with this pain when it comes or do procedure such confusion .

          • It is impossible to diagnose a case like yours remotely. You can perhaps be referred to a tertiary center.

  4. Hi I am a 23 year old female I had my Gullbladder removed a year ago and er doctor told me it was a good idea to see my surgeon again because my bile duct was dilated when it wasn't in previous scans what could this mean I have severe upper quadrant right pain so bad I can't walk at times nor breath and super bad nausea and the pain is worse than before it was removed should I be concerned?

  5. My father is suffering from locally advanced carcinoma Head of pancreas, Underwent SEMS just a month ago.That time CBD was dilated 14.2 mm now its 25 mm. The dilation of CBD again created obstructive jaundice with cholangitis.Is a by pass surgery possible in this case.

  6. Hello,
    Sorry about your fathers condition.
    The dilated common duct and the cholangitis are the result of the obstructive tumor.
    Choledochojejunostomy, or choledocoduodenostomy and even whipple procedure are thoertical option. These all depend on the extend of the disease.

  7. Hi there. I have multiple orthopedic problems, afib, and neuromuscular disease, type unknown, and am on tons of medications. Had gallbladder removed 3 yrs ago, due to multiple stones, ongoing pain and nausea. A high-attenuating lesion was seen on liver at that time, but I was not informed of it. I had a mild reaction to tuberculosis test 8 years ago. Pain continued, is often excrutiating and am having nausea again. Often can't make the 189 mile round-trip to ER till days later; liver function tests then show within normal limits. Have lost 60 lbs. New CAT shows lesion has not changed much; doctor hasn't returned my calls. These are govt. drs., and don't have insurance anymore. Can you suggest anything I can ask my doctor to test for or ask about…I am at a loss as what to do, and am so sick now I'm almost helpless. Any ideas could help.

  8. Does it continue to dilate further over years? Recent studies show increased dilation by quite a few mm as I have been continuing to have gallbladder attack like symptoms every day. Mine was remove in 1990. Has gone from 10 mm to 13 mm in the last year and a half according to this weeks sonogram…presently awaiting mri results to look further.

  9. Had CT for lung mass, then bronchoscopy – all OK – NO Ca.
    Coincidentally CT picked up dilated CBD. I think I was copied into a letter possibly in error which is how I found out. I do have FU appt – what is likely to be done by way of investigations – have never had Gall Bladder surgery – only symptom is quite severe upper right abdo discomfort plus generalised abdo discomfort and weight loss.

  10. I had my gallbladder removed in 2004. The pain prior to the removal of the gallbladder was excruciating To the point of complete delirium I was told by The surgical team that there Were numerous gallstones and apparently they were not all removed at the time of the gallbladder surgery, henceforth I developed gangrene. I was sent to San Francisco to a specialist who performed an ERCP and after two weeks in the hospital and several months of recovery I am still having issues! I was told it was only scar tissue , but an ER doctor recently told me My common bile duct is dilated , Could it be possible that one of those gallstones could still be lodged in the common bile duct after this many years?

    • Hello- If the stone in the common duct is seen before 2 years then it is considered a retained stone from the time of the gallbladder surgery. IF the stone in the duct is seen after two years of the gallbladder surgery then it is knows and “Primary Biliary Stone” (PBS).
      PBS needs treatment, ERCP or surgical at times.

  11. Hello. Had an MRI four days ago, findings are “common bilary duct dialation” I had my gallbladder removed over a year ago. I also have crohns disease. They are ordering an ERCP and marked a referral “urgent” to the Medical University in my state. I have had pain when I eat for Seven- months. I asked for an MRI i am always told it’s a “crohns flare” when I go to the doc or ER. My blood work isn’t great as far as markers for pancreatitis and “liver function” which I know could mean an abundance of things… they say it may be a “complication” from a previous surgery. My question is, why are they sending me to a surgeon?

    • Hello- I can not answer why you re being sent to a surgeon. The reasons for evaluating this further is the association of Primary Sclerosing Cholangitis” with patient who have inflammatory bowel disease. This association is much more common with the Ulcerative colitis that the Chron’s disease.

  12. Hi I 37 years old and have IBS and have a small gallstone. The doctor told me that I have a dilated common bile duct and need to see a gastro. Is that bad?

    • I think you should see a surgeon- and not necessarily a Gastroenterologist.A gallstone in the common duct, can become a surgical emergency.

      • I went to the hospital over the weekend for one problem and after a ct and an ultrasound, the dr came in and told me I had a dilated bile duct and would need surgery. He didn’t make it sound like a huge deal but after reading through these posts, I am definitely more concerned. I still have my gall bladder. He did say it was full of stones as well. Is this an emergency?

        • I can not comment if something is an emergency or not. Please contact your care provider.
          Thank you

    • The common duct is the tubular structure that delivers the bile from the liver-gallbladder to the small bowel. When the gallbladder is removed, the common bile duct dilates. If a patient has a dilated common duct and still has their gallbladder then this is much more source for concern.

  13. Hello,
    I am 34 years old and have had terrible upper abdominal/shoulder pain, nausea and vomiting off and on for 2 years. I had an ultrasound 2 years ago that showed a 12mm common bile duct, everything else was normal. All of my blood work is normal. Was told I had sphincter of oddi dysfunction. This summer the pain came back with a vengeance. My common bile duct was 17mm, distended gallbladder with wall thickening, no stones/sludge, normal blood (except elevated WBC). Diagnosis of Choledochal Cyst, but no-one knows what that is or what to do with it so sent me to have my gallbladder removed, surgeon again said I had a choledochal cyst. Sent me to Washington University, did an MRCP, normal blood again and agreed I “probably” have a small type 1C choledochal cyst. They want to do another MRCP in 6 months. I still have terrible pain & nausea. I was under the impression choledochal cysts should be removed. Could 17mm common bile duct be something other than a choledochal cyst? Thanks!!!

    • Hello,
      You said “.distended gallbladder with wall thickening, no stones/sludge, normal blood (except elevated WBC)”
      You have cholecystitis and your gallbladder needs to come out. Other compounding variables are: diabetes, obesity, pregnancy, smoking.
      The rest of the information is sort of irrelevant until your gallbladder is out.

      • Thank you for your reply! I had my gallbladder out 2 months ago but am still having symptoms. MRCP showed my common bile duct as 17mm last week. It’s suspected I have a small choledochal cyst, but because it’s so small they want to do another MRCP in 6 months rather than surgery. Could my gallbladder have dilated my common bile duct? When does a bile duct go from dilated to choledochal cyst? Thanks again.

  14. I am not sure gallbladder dilates common duct. Gallbladder removal over time will result in dilation of the common duct.

  15. hello, 47 year old woman with hep c. no cirrhosis or fibrosis. alt & afp Levels high and ultra sound showed a small lesion on spleen and common bile duct blocked. Dr wants to skip MRI and do ERCP. Im reading that can be risky but he says its the best way to treat/ see whats going on inside and scheduled me for the surgery. Any advise on if I should push MRI first or just get the procedure done? Would prefer to avoid any invasive & risky procedures if not needed. Thanks

  16. Feeling very scared, wondering if you can provide some insight. A few days before XMAS had some terrible discomfort in right upper quadrant (below rib). Mind, this has been ongoing for several years, the discomfort. 2x in the past it resulted in a trip to the ER because the pain was severe. Last trip was about a year ago, everything showed normal and I was sent home. This most recent trip showed a dilated common bile duct 5.8mm, previous had been 4mm. The see no “stone” and have “suspicious for obstruction” on the comments. My question is, I feel this has been an ongoing issue for years. Is this something that can flare up and then go away? I have nausea nearly every day, I have been used to it for years and years. Sometimes it’s worse than others. I have a GI appt this Friday. Feeling very anxious, so scared that I’ve can’t stop crying.

    • Hello Your question raises more questions and I can not answer it intelligently.
      1-do you have a gallbladder?
      3-did the pain follow any fatty meals?
      4-any weight gain or weight loss
      5-any jaundice?
      6-and other questions.

      Please see the GI specialists and will require an Ultrasound, possible HIDA scan, possible ERCP or MRCP and other tests in addition to blood work.


  17. I have been told that I have a minimal dilated common bile duct. . What does this mean. Do I need my gall bladder taken out.

    • Dilated common Duct may mean a number of things. Is the dilation associated with any pain? jaundice, fever or it was just picked up incidentally? Age is also a factor. All these are best addressed by the treating physician.

  18. I had my gallbladder out about 3 mos ago then still having the attacks and itching I was referred to GI specialist and since my biliary duct was up to 13mm they said I had blockage. I had a tumor that was removed then ended up with pancreatitis the next day even with stint. It has been a month and a half and I still can’t eat most food and having pain and pressure in biliary duct. They did a ultrasound today and duct is only down to 12mm. I don’t have an appt with my surgeon for another week so I’m just wondering if it just takes a long time for swelling to go down or could it still be a problem.

  19. 51 yrs female. Has multiple max size 8mm gallstone and filling defects in cbd. In mrcp cbd dia found 13.7mm. After that in Feb 2017 ercp done and 2 stone 7.4 dia removed. After ercp again mrcp done. It shows dilated cbd 14 mm. GI surgen says that gal bladder and CBD both needs removal.Is Dr. right.

    • Hello, I think you need to clarify this- I do not thing your CBD (common BIle duct) is going to be removed unless there is a tumor or a mass in there. If there is(are) stone(s) and the gallbladder is removed, then a connection is created between the CBD and the duodenum.

  20. Hello, I need clarification on this, my friend went for MRI and it was found out that her gall bladder is enlarged…is there a remedy for this and what should be done for her

  21. Hello, I am female 49 years old, and back in january 1999, I had my gallbladder out. I have had CT scans over the course of time since then, not many, but there was never any dialation on the CBD even my CT scan from June 2016 it was fine. For this last year, I been declining, not eating weight loss, low grade fevers they run from 99.2-101 I am severely fatigued whole body fatigued actually, and I am continuing to go down hill right now my weight loss is 2+ pounds a week (that is a conservative number), I have been going thru tests and they repeated my CT scan end of March 2017 and now I all of a sudden have a 7mm dialated CBD, my wbc and alt and ast and such are normal- I do have some tests that are off, but are urine related, I currently have and had trace blood in my urine the past year, my creatinine is a touch high but not much, it is 1.3 (range is (0.5 – 1.2) , urine squamous epithelial cells 3+/lpf and my estimated GFR non african american is low 44 ( range >60) urine bacteria 1+ and urine mucous 1+ and Potassium is a tad low 3.2 (range 3.4-5.4) Ohhh I have stage 3 kidney disease, sjogrens syndrome, swollen lymphnodes in my neck and my right armpit feels like there is something in there when my arm is at rest, I had a rare septecemia May 2016 with no cause, was deep in the muscle that ran from the sternum to the left AC joint, no sores no cause,( kidney disease came from this as the septecemia ) that is why I had a ct again back in June 2016 and my CBD was normal at that time as I mentioned. My symptoms, extreme nausea no meds help, vomitting, weight loss, whole body fatigue, whole body aches, low grade fevers, ohh and last spring 2016 for the first time a 3mm angular nodule in the upper right lobe of the lung was found, and the recent CT march 2017 showed same nodule same 3mm but a new change is Linear fibroatelectatic change is present
    within the inferior lingula. so because they say my blood work is normal, besides what I listed, they dont’ know what is wrong, any ideas? I know the CBD can dialate over time, but in 18 years, there was no change to the CBD after my gall bladder was removed back in Jan 1999, until March 2017, and not even last March 2016 it was normal and now 7mm out of the blue…I am confused, should I be going for a second opinion or do I have nothing to worry about as, the Doctor said if it was serious, my blood work would be bad, such as ast and alt and whatever else . Any suggestions at all, or is this just going to be this way. with my symptoms I am confused, and these symptoms over the last year have been getting worse and worse and worse (a gradual decline) and the last couple months the decline is going a little faster now. I understand my dr says there is no cancer, due to my blood work being okay, but there is something wrong, becaue this is not normal for me this past year.

    • Hello
      I would certainly get other opinions given the complex issues that you have listed.

      • Do you have any suggestions, that I could possibly bring up to my doctor, that maybe they are not thinking of, or at least I can discuss with him?? With your expertise, I would appreciate that.

  22. I am a 59 y.o. Hispanic female, I got my gall bladder stone removed 15 years ago. One year ago, I started having pain in my right side upper quadrant.An ultrasound revealed my CBD was 7.6 two months later was 6.3. I went to see the doctor on August 24/2017 , she ordered another ultrasound , which revealed the Common Bile Duct has increased to 12 mm in less than a year. No symptoms, no jaundice. I just was referred to a GI doctor. What could that be. I am really worried. Thank you for your response

    • Hello There are a number of possible explanations for the change in the size of the CBD. More information is needed.

  23. I am a 66 yo male. Laparoscopic cholecystectomy to remove gallbladder in 2011 due to low function…. 16%. No gall stones present. Off and on, slight and infrequent pain in same location as gallbladder, usually short-lived. About a month ago, began to experience same kind of pain, but it has been much more frequent. No vomiting. Have seen my GP and he had all sorts of liver/pancreas blood tests done…. all came back normal. I have NO jaundice, but some diarrhea issues similar to right after my surgery. GP is sending me for an ultrasound. I have severe anxiety issues, and always imagine the worst-case scenario. Could this simply be pain from my bile duct having dilated over the past six years? Even though I had no gall stones in my gallbladder, could a stone have formed in the bile duct? Called gastro doc’s office and spoke with nurse. She said to see GP first and he could do all sorts of tests to determine if I needed to see the GI doc. She said my pain, queasiness and diarrhea issues could simply be from “a bile dump” …. not exactly sure what that means?? I know you can’t diagnose based on this limited information…. but I would certainly find some peace of mind and lessened anxiety if you could tell me some things this *might be*…. other than something terminal. Thank you!

    • Hello- this can be cause ny a number of things. Please se by your PCP, GI or surgeon for a complete evaluation.

  24. For almost 3 years I have been experiencing pain in my right front rib and mid back. Blood work has always been good. Ultrasound showed no stone or sludge but did show a slightly dilated common bile duct. Doctors said it was nothing to be concerned about. I had a colonoscopy and endoscopy. All good. Recently I had a CT scan and with the exception of a hiatial hernia all was good. This evening I had dinner and had some acid reflux and my back and rib have been hurting since.

    • As we all get older the common duct dilates. Should consider Dynamic HIDA scan, and see a surgeon (not necessarily a GI) for surgical repair of the hiatal hernia.

  25. I have had an elevated liver enzyme for a few years. I had an upper right quadrant ultra sound that showed sludge in the gall bladder. I went to a GI and he said that the elevated enzyme may just be my “normal” but wanted to run other blood tests…those tests came back showing the slightly elevated enzyme as the same as before. He suggested that we do a liver biopsy just to be sure. I had that procedure done last week. All the tests results of the biopsy came back showing no abnormal liver function but that I had CBD measures up to 10
    mm in diameter. It tapers smoothly into the region of the ampulla. The
    gallbladder is not distended. There is high density material in the
    gallbladder probably contrast medium. The rest of the abdominal organs
    are unremarkable. With that said, I have never had a dye test of any kind so what could the “contrast medium” be? I have a follow up appt with my doctor on Jan 22nd to go over all of the test results.

  26. 53 year old Female had my Gallbladder removed 4 years ago. I was told and shown a photo my Gallbladder was embedded in my liver. I have been having severe right upper quadrant pain within a few months bile duct dialation went from 5.5mm to 10.5. I had MRCP no stone or blockage found, Liver enzymes elevated and have tripled in just 2 days. I have been referred to GI specialist however the pain is nearly unbearable. I also have hemochromatosis. It has been 4 days since my last bloodwork. Is it safe to wait to get into a GI Dr. or should I return to the ER. Pain meds are not helping. Thank you

    • Hello, IF you are in Pain you should be seen in the ER. You should call your primary care and ask for their opinion.

  27. Hi Had my Gallbladder out in 2013. Found lots of stones. A year latter the same pain I had when I went in for my gallbladder surgery came back. Had an endoscope and a colonoscopy, Nothing noted that was remarkable. Pain went away mostly would come back here and there, off and on. Since Jan. 2018 the pain has been constant. My liver functions have always been normal, even when my gallbladder was removed. Just had mri and it says that my common bile duct is dilated to 1.4 cm it says there is no evidence of stones and there is no biliary stricture or evidence of a biliary or ampullary mass. Says it’s possible it could be an ampullary stenosis. Says that common bile duct abruptly tapers in caliber at the ampulla vater. If I do not have bloodwork that is off is there anything they could do for the pain?

    • ERCP and sphincterotomy may be what may be needed. Have to also consider bile reflux gastritis as a possibility.

    • Hello, my immediate assumption would have been a retained stone left over from the GB surgery. However assuming that the MRI, (MRCP?) no stone was seen, then on has to consider other possibilities. Was the surgery straight forward? was there an intra-operative cholangiogram done?

  28. Maybe you can help me… I went to the er a month ago And I’m still having pain. ( my symptoms include… Pain and burning in stomach… Nausea everyday… Back pain.. Bloating I’m tired all the time I wake up sweaty i had a swollen lymph node in my throat (nowhere else) that i thought was because of a tooth ache i was having ) I had my gallbladder removed in 2004, since then i had a hysterectomy 2012 endometriosis (found during hysterectomy) gastric bypass 2014 and pancreatitis 2 months after that surgery) when I went to the er they wrote…
    Mild intra and extrahepatic biliary ductal dilatation could be
    related to the prior cholecystectomy but is greater than typically
    seen in a 35-year-old. If there is concern for biliary stricture,
    MRCP could be used for further evaluation.The patient is status post cholecystectomy. common
    bile duct measures 1.2 cm. No stone is seen within the duct. No
    focal liver lesion.
    So I’m concerned now if theres no stones what could it be? My doctor is taking a lets wait and I’ll give u an option of what you want to do approach( he said we can wait and see, a mri or endoscopy what do you want to do) I do have a family history of cancer in the family ( father prostate, uncles and aunts on mothers side-stomach,lung, breast,liver cancers) is it possible to get stones 14 yrs after removal… And wouldn’t it have been found during other bloodwork drawn for other surgeries? I have an endoscopy scheduled in 2 weeks but I’m still constantly in pain.

    • Not sure if what you are experiencing is related to the biliary tree of a complication of the gastric bypass. See your weight loss surgeon and if with simple test nothing is identified, then you should be taken to the operating room for an exploration, lap or open.

    • Hello, With gastric bypass, you need to make sure that there are no internal hernias that may be causing the symptoms you are having. Could they also be dumping symptoms? See your bariatric surgeon.

      • Yes, I’ve had a intussuception and needed emergency surgery in November then in February they noticed that my jejunal anastomosis was too large so the did a Jejunojejunostomy in February. I now have bowel wall thickening and some swollen mesenteric lymph nodes. I have a ERCP with sphinctotomy scheduled for July 7th. Thank you so much for being available to us I was admitted to the hospital and was told I had intractable abdominal pain that I needed cognitive therapy. So thank you so much for hearing our concerns

  29. Hi Dr. i suffer from chronic constipation and have become pretty dependent on Over the counter laxitives for years now. To lose my last 10 baby pounds, about 5 months ago i out myself on a 1250 calorie a day diet and drastically increased my fiber in take to probably over 30g and increased my water intake to 60-80 oz a day. Im not sure if my problems were caused by my new diest and fiber increase (as ive always suspected fiber intolerance), but my constipation got worse, and laxitives stopped working all together. Enema and suppositories also have not helped. Increasing more fiber and water seems to just make things even worse. Oh and even worse, i have gained 9 pounds so def not the direction im was aiming for. I am taking excessive laxitive to have some relief but nothing is happening, not even after taking prescription. Finally my primary suggested i see an GI specialist and had a CT scan in the meantime. Other than the horribly itch skin which keeps me up at night, i don not have any of the symptoms of blockage, i have seen any weightloss in fact the exact opposite and i do not have unbearable pain. However i have constant bloating, and abnormal flatulate and smell. My CT scan result indicated some concerns but i wont know what it all means until i see the GI, which wont be for another few weeks. My ct indicated i have: dilated CBD, liver enhaces homogeneously without focal mass. It is of mildly diminished attenuation suggestive of hepatic steatosis. Mild intraheptic biliry ductal prominance with dilation of the CBD measuring 12mm in thecoronal plane. Spleen enhances homogeneously and not enlarged; Galbladder is mildly disentended but no gallcified gallstones or associated inflammatory changes; small bowel without obstruction; modorate stool throughout entire colon; mildly prominent lymph nodes within the mesentry but no confluent or pathologic mesenteric lymphadenopathy. I dnt know what all these mean, i have exhausted the Internet trying to figure out something until i see the GI…i cant see continuing like this until i see the GI? I dnt have pain but i am extremely uncomfortable, finding it hard to be active, so ive stopped my daily exercises, i’ve just in the last few days stopped with the high fiber diet, and the itchy skin is unbearable. Not sure if ER will actually do somethjbg by getting a GI specialist to see me asap or will they just send me home only to make an appt at a later time. Im also worried if by the i see the GI thigs could get more complicated or even an infection. Any suggestion you can offer will be greatly appreciate it! Thank you.

    • Weight loss may cause biliary stone formational If a GB has been removed the CBD may dilate. Gallbladder dysfunction needs to be evaluated with a dynamic HIDA scan. Please see your primary care physician.

  30. Hi Dr. Ara, for the past 1 1/2- 2 years I have been having RUQ pain off and on. Sometimes it’s just an aggravating discomfort, other times the pain is so severe I can barely move. The past few weeks/ months the pain seems to be getting worse and more frequent. 2 weeks ago I went to the ER because the pain was so severe. My LFT and other bloodwork came back normal. I had an Xray and ultrasound done and the only abnormality that they found was biliary dilation with Common duct measuring up to 10mm. I have an appointment in 2 weeks for an endoscopic ultrasound. My question is: would the dilation cause severe RUQ pain? I get intense pain in my upper right rib area. Sometimes the pain shoots through to my back, right around my right shoulder blade. Other times it goes to the center of the upper chest area. I used to get the pain off and on with at least a week or two in between without any pain. Lately, the pain is every single day and it is seriously affecting my quality of life. I don’t have any jaundice. I’m not overweight. I am 39 yr old and I still have my gall bladder. Is it possible to have gall stones that aren’t visible through an abdominal ultrasound? Or can the dilation be the cause of this pain? Thank you for the opportunity to ask you my questions and voice my concerns.

    • Yes, RUQ pain may be indirectly related to the CBD dilation. GB may look normal on ultrasound and not function. May need dynamic HIDA scan. A “normal” ultrasound of the gallbladder does not rule out dysfunction.

    • Theoretically it would be nearly impossible to have stones note picked up by one of the many diagnostic studies.
      Other possible causes should be also studied – ulcer, gastritis etc by endoscopy.

      • Dear Dr. Keshishian: I have read many of these posts concerning severe pain after the gall bladder has been removed, many years before. I had my gall bladder removed in the early 1990’s. Dr. said I had a thousand tiny stones. Later, I found out if I took Tylenol, or Percocet, I would get severe pains. I can take Ibuprofen with no problem. I ended up in the emergency room twice (once years ago, and once recently when I took Percocet for severe pain from a budging disc in my upper back, pain in my back, shoulder and arm when Ibuprofen did not help) and the emergency room they said it was indigestion, but I have never had pain this severe from indigestion before. I have taken multiple doses of Gas-X and 2 or three Tums and that usually relieves the pain. At one time, an emergency room nurse gave me an injection (don’t know what) in my thigh for the pain. It relieved the pain in my chest and back, but the pain from the injection in my thigh lasted quite a while! bummer. I just wanted to let people know that Tylenol or medication with Tylenol might be the cause of their pain. I have never had liver disease, and I don’t drink alcoholic beverages. I am now 75 years old and recently had a CAT scan for several bladder infections and an MRI for the budging disc. They said that my common bile duct was 13 mm. I have had quite a bit of stomach and gut problems over the years. They just did a blood test 5 days ago, and said I did not have Hepatitis.

        • Hello, I am not aware of a specific pain caused by Tylenol. We know that Acetaminophen (Tylenol) is cleared and proceed in the liver and at high doses ( over 4gm / 24 hours in adults) is toxic to the liver.

  31. Hi, had previous removal of gallbladder over a year ago. And went to ER recently experiencing ongoing RUQ epigastric pain. Have deranged LFT’s and so was referred for an MRCP which should dilation of the CBD to 10mm. Thus was referred for an ERCP which found no stones or anything. Hence would could be the reason for experiencing pain ? And why was I referred for an ERCP ?

    • I could only assume that ERCP is ordered to only confirm that you have no blockage in the biliary tree but also to possibly dilate the sphincter. You should ask you treating physician for sure prior to undergoing any test or study.

    • Many reasons possible. May need an upper endoscopy. Assuming ERCP was done to make sure you had no stone left behind in the biliary tree.

    • Hello, The pain may be caused by adhesions (scar tissue) or other conditions such as ulcers. All these need to be evaluated including an upper endoscopy. ERCP, which will include and upper endoscopy is recommend to see if there is a stone in the plumbing of the liver and the biliary ductal system causing the LFT’s to be elevated. Please see your PCP for more detail.

  32. I had a pain right up in my right underneath my breast bone right in the middle went to a gastrologist all they find is that on my bile ducks are dilated 9 cm I had all the test that for pancreas they said there’s no cancer no stone but nobody knows what’s going on why are my bowed ducks dilated nine help please

    • There are a number of reasons why the bile duct may be dilated. Will need blood work, and additional studies such as CT scan, MRCP or ERPC ultrasound as examples. See your PCP please

  33. 42 year old female, still have my gallbladder and have recently had an Er visit with severe pain. Referred to a Gi and got a endoscopy done. Everything looked normal but high cell levels on upper small intestines, got blood work for celiac disease, all came back normal, just got ultrasound, liver & gallbladder look normal and it says dilation of CBD 6mm radiologist recommendation is a MRCP, They-ordered bloodwork for my liver and they are normal also. Now getting a stomach emptying test and a hida scan.
    I guess my question is, what could this possibly be. I get scared to eat because I can not go through that pain again. What are they suspecting or are they just going over everything? All these test have me in panic mode. Thanks 😊

      • Because you still have your gall bladder the dilation of your CBD means it has a blockage (normal CBD is about 3.5 mm), probably a stone or other blockage

        • The gallbladder was removed. In young population CBD dilation is seen after GB removal. AS we all age the CBD may dilate. Your are correct that in a young patient CBD dilation may be an indication for some sort of blockage.

    • I am 47 been suffering for 3yrs all test come back normal but . Recently went to er couldn’t take the pain and missing so much work. I have a 6cm dilated bile duct. Hida scan soon. Ores very frustrating i know something is wrong i can feel it after i eat.

  34. I have advanced polycystic kidney & liver disease. And. U/S showed atypical lesion in liver. MRI without contrast stated scan was sub-optimal for dx RCC and HCC, need contrast. It also said CBD is dilated at 9mm towards the ampule. I have low GFR so contrast is out. Should I be concerned.

    • Additional information is needed, Age, previous cholecystectomy, of pancreatitis, diabetes. etc.
      CBD dilates with age, cholecystectomy and other conditions. Dilation may be the results of of one of those mentioned or may be sign of something much more serious. Please see your PCP.

  35. Hi had gallbladder removed 28years ago suffering severe pain and found 30 gallstones,woke after the surgery in excruciating pain to be told by nurse it was just wind. The drainage system also took more days than other patients in hospital .was sent home and suffered this pain on and off for a these years going back to hospital numerous times to have ultrasounds to be told cannot find anything.this time only 2 weeks ago in hospital was given xray and mri scan to be told had found numerous stones in cbd with moderate obstruction.because of the suffering on day 1 of gallbladder removal have these been left all these years?liver function tests are also abnormal

    • There may be many reasons why liver function test are elevated after cholecystectomy. Test and blood work may direct the work up. Please see your PCP or a surgeon.

  36. Hi 33female. Slight back ache and sometimes little pressure on right hand side. Had ultrasound and ct scan nothing comes up, only a prominent cbd of 6-7mm ultrasound said 6mm and ct and 7mm. Nothing found. My doctor said she isn’t concerned about it and would like to leave it! I did have cholestatis while pregnant but that was 6 years ago. I do get heart burn and my last liver test was a little off but not major, ct showed slightly fatty liver. Having a repeat blood test but no idea why bile duct is more! What can I do? Doctors aren’t worried about it and said could be normal for me!

    • This may be related to gallbladder or reflux. May need further studies to identify and isolate the probelm.

  37. Hi Dr, I have been suffering from stomach, back and chest pain for 3 years now. I have done numerous blood test and all came back normal. I was at the ER 3 days ago due to severe back ,stomach and chest pain and this was accompanied with fever. All my labs came back normal and my blood pressure was fine but my pulse was high. Ecg was done and was normal and xray came back normal too. i was diagnosed by the ED provider with biliary colic. CT scan showed mild dilated common bile duct without any evidence of cholecystitis, cholangitis, or still in pain and I have been referred to a GI but I don’t know what to do now because I have no insurance. Thanks

    • You should follow up with the GI, there are many causes that may present with the finding and may need ERCP or MRCP.

    • You may have to have your gallbladder removed. There are patients who have nonfunctional or poorly functioning gallbladder with your symptoms.

  38. Hello doctor ,
    My wife had acute cholecystitis, so doctor suggest to have a gallbladder removed, surgery done,and after week my wife gone throught the right side below chest pain for almost a week now after having food and some times before having food also and it will lasts for 1.5 hrs,

    And surgeon asked us to take blood,urine,cut scan endoscopy and Finally MRI also they said everything is normal even we dont know what’s the cause for the pain and all.

    And finally a doctor said the found the dilated CBD of 2mm .So now what do we do please suggest and help us.

  39. Right side back pain below chest after having door or some times before food and now today even while sleeping when turned up also the pin started and its lasts for 1.5 hrs and stops when we give pain killer injection.

  40. Hi, My mother has been tolerating pain for so many years now. She can’t sit for long. She has to lie down. My mother’s upper abdominal hurts a lot whenever she sits at a place for too long or whenever we go to a 5-6 days tour or some kind of marriage function, she has to be hospitalized or has to be given medical attention in these occasions. She accumulates a lot of GAS in her upper stomach which leads to heaviness and difficulty. Whenever I press her back or her shoulders and give her massage, she starts burping and she burps a lot (a lot!!), it looks like the gas been trapped! She has asthma. She had her gall bladder removed 12 years ago in 2009. Now, the tests show: Mild hepatomegaly (liver size: 15.8 cm) AND the report says, “Post cholecystectomy status is noted. CBD measures 9 mm and shows distal smooth tapering at its distal end.” What does it mean? It shows distal smooth tapering? Please provide a detailed answer. It will help me a lot and make my mother’s life easy. Thank you Doctor.

  41. My 94yo father was in the ER last evening. They found that he has extremely elevated liver enzymes; (tot bilirubin 4.0 (0.2-1.3, direct bilirubin 1.7 (<0.4), AST 343 (17-59), ALT 351 (<50), Alkaline Phosphates 169 (36-126), NT-Pro-B Natriuretic Pep 2890 (<300); a 2.5cm soft tissue mass anterior wall gallbladder; multiple gallstones; gallbladder 2.6mm in thickness; common bile duct is dilated 14mm in diameter; left kidney 10.4×5.0x5.8 with 2.8cm simple cyst inferior margin. He has dementia, has been in a Nursing Home for 1 year. We do not feel that he would survive any form of surgical procedure. We are considering HOSPICE and was wanting to know what to expect for him in the near future.

  42. Hi Dr my mother’s gallbladder has been removed 18 years ago now she is suffering severe pain. In mrcp test it found dilation of common bile duct 12mm dr please tell me about it treatement.

    • She may have formed gallstones in the ducts after gallbladder removed. Its called primary biliary stone. After MRCT she may need surgical removal of stomes and additional procedures.

  43. Hi,
    I recently had two mild episodes of RUQ pain radiating to back and had bloodwork drawn. Results were normal but my Dr. ordered an ultrasound that revealed gall stones and dilated CBD at 13.7 mm. So was referred for MRCP that confirmed gall stones (largest at 17 mm) but no dilated CBD and liver and pancreas unremarkable. So the prognosis was to not do anything since I am no longer in pain. Upon reviewing and older CT scan (for different reasons) there was mention of air filled gall stones. Should I be worried about difference in what the ultrasound and MRI results showed for dilated CBD? Should I be concerned about gallstones (confirmed on three different methods and one indicating air filled stones? Should I have my GB removed to avoid future attacks? I am 46 year old female. Thanks.

  44. I am glad I found this blog where it talks about something that I am experiencing. I as well have discomfort in my upper left stomach, under my ribs. My situation started since I started working from home due to the pandemic. I have also gone to my PCP and Gastro doctor for this situation and they all tell me that it seems to be muscle related from sitting so many hours. I have had blood work done and shows nothing to worry about it. I had an endoscopy/colonoscopy done and everything was fine. They also ordered me an ultrasound and all my vital organs were fine, there is a small inflammation in the bile duct, but they say that it is normal when they remove your gallbladder. I do not have pain, rather discomfort, especially when I am sitting or lying down. I also have a hiatus hernia and suffer from acid reflux, but my Doctor tells me that will not cause that symptom. It is frustrating to be in that situation and not knowing what is happening. You always think the worst and that’s not good either. Do you think I might have stone in the Bile duct?

    • hiatal hernia can and will cause the symptoms. There is a common finding to have the hiatal hernia be dismissed by GI. See a surgeon

  45. Hi…It took me 3 years to find a doctor that would be able to help me. I went to the ER 2 days ago and they referred me to a general surgeon. Thank you so much. I’ll keep you posted on the findings. The ct scan showed exactly what you said… Possibly a internal hernia or small bowel obstruction… Im going to see if they could also look into the possible stone in my cbd. I wish you weren’t in CA I would have made an appointment with you a long time ago.

  46. Hello! I am a 48yr old female who’s undergone 1) Cholecystectomy 2012-due to severe persistent URQ pain, CBD dilation 18mm N/V, weight loss of 30lb, and supposed gallstones; yet none found post-op 2) Ampullectomy 2013 due to benign adenoma, persistent symptoms above.
    Since such time I had reoccurring episodes of pancreatitis post-op for approximately 1yr post-op. These episodes subsided and I’ve had episodes since, but usually when I’ve eaten foods that are more difficult to digest such as nuts, red meat or something that’s oil/fat laden. Over the past 4mo I’ve had unintentional weight gain of about 13lbs, abdominal bloating, feeling of fullness after eating small amounts, abdominal distention, episodes of URQ pain and pancreatitis. I recently had an MRI for unrelated issue which showed CBD dilation of 10mm. The last post-op US I had was in 2015, and at that time which read: “Patient has pneumobilia. This can sometimes be seen post chole, but has multiple other causes. It was not seen on previous scan, and there is worsening pancreatic duct dilation at 5mm . This should be further assessed”. At that time I was told that this was a possible outcome from chole and that it should resolve in time and no further testing was done. My recent LFT were all WNL’s and my GP referred me to surgeon should I continue to experience symptoms. I reached out to surgeon with recent MRI result/current symptoms and he said that CBD dilation post chole is normal and there’s no indication to reassess with ERCP.
    My question is: should I insist on further intervention to rule out possible recurrent adenoma or CBD obstruction?? It was concerning and baffling to me that he was so dismissive and reluctant to investigate further. Any advice you could give would be appreiciated!

    • Pneumobilia is possible the result of the ampullectomy (this may mean many things, surgical or balloon dilation and cauterization). I would GUESS, that you do not have an obstruction and possibly cholangitis (infection of the biliary tree) caused by the gas and the bacteria being able to travel up the duct with the ampulla open. maybe worth while to see if the symptoms improve with Flagyl (antibiotics) Cholangitis may present with abdominal pain, elevated liver function test elevated white count. Not all of which may be very high.
      Another possibility may be adhesions from the surgical procedures you have had.
      MRCP with contrast may also be a good alternative to ERCP since it will not only image the duct but also possible adenoma recurrence.

      • Thank you for your prompt reply! I did speak w/ my Gastroenterologist and he did in fact confer w/ my surgeon in regards to symptoms & MRI result. They agreed that MRCP or ERCP would be good approach considering it has been 7yrs since my last biopsy to f/u adenoma. I will be getting scheduled soon and hopefully will have more answers. I did also consider the possibility of adhesions as I have developed a considerable amount prior post laparoscopic procedures & from stage 4 endometriosis. Cholangitis has never been discussed, but I will inquire more when I meet with them. Thank you again!

  47. Thank you for answering so many questions. I tried to read through them all to be sure this wasn’t repeated. Would a stone (post gallbladder removal) show on a MRCP? Most likely or is there always a chance they/it could be missed. Also, any thoughts on why radiologist use language such as “no aggressive” intraheptaic lesions. I realize this is good; yet it would be better just to leave it off as it leads one to think there are other lesions and maybe lesions in general are just a normal part of aging. Most everything on the MRCP says no aggressive or no significant … I’ll take it as a win; I’m grateful. Many people are going through much more and my prayers are with them. At this same time, if I could nail down this being tied to a bathroom and unable to eat thing…. I’d be really happy. Weight loss isn’t pretty when you have no strength or muscle tone 😉 Thank you for all the educational information. You have a servent’s heart. Prayers for all.

  48. My daughter left the ER just a little bit ago and they sent her home with 500mg naproxen and paperwork on pleurisy. When I looked up her test results in the patient portal it doesn’t show any pleurisy. The ultrasound shows incompletely distended gallbladder making gallbladder walls loon thickened with no gallstones. She has really bad pain on her right side up higher and if she laughs, sneezes, or coughs it hurts even worse. I’m just not sure where to go from here.

  49. Hello, IF the pain is worse with eating, specifically fatty meals, then further workup of the gallbladder function is needed. A Dynamic HIDA scan may be needed. Additional pieces of information will include detail of the laboratory studies.
    She needs to be seen for a complete work-up if her symptoms persist.

  50. Hello, my mother gallbladder removed 5.6 years ago. Now she is having stomach pain ( 4 times ) in last 2 weeks. So we doctor suggested LFT and ultrasound test.

    CBD dilated ~13MM. No evidence of obstruction lesion seen.

    Doctor suggested to take Ursodeoxycholic Acid (300mg) 2 times for 5 days.

    Can you please recommend if we need to go with MRCP or EUS. Or there is any procedure to find & remove stone from CBD from glabladder duct, as there is clip & glabladder already removed.


  51. Hello 🙂 so I had an scan that showed my bile duct is dialated at 7mm. They wrote that 7mm is abnormal. I have severe pain in my upper abdomen that is triggered by eating, reflux, nausea. Could I possibly have a stone in my bile duct? What tests would show that?

  52. I have been diagnosed with RCC, and have a lung mass that will be biopsied along with my kidney. The kidnet ct scan noted: There is mild fatty filtration of the liver. There are 2 subcentimeter low-attenuation foci within the liver, one in the lateral segment of the le! lobe on image 29, the second more centrally on image 26. These are too small to characterize. There is mild intrahepatic biliary dilatation. The gallbladder is notable for multiple calcified and partially calcified stones. There is dilatation of the common bile duct to 14 mm. The duct is dilated into the head of the pancreas to its distal aspect. There is no obvious calcified stone here although there is fairly abrupt transition. See images 79 and 80 series 5. A strategically placed

    nodule or subtle mass should be considered given the distention of the common bile duct and abrupt transition. ERCP could likely further evaluate and possibly treat and is suggested. Is it possible all the dilation is caused by RCC metastasis?

  53. Hello looking for some insight, I have had elevated LFTs for the past 3 months, only ALT and AST are elevated. Last tests were ALT 81 AST 54. I was sent for ultrasound and everything came back normal except my common bile duct was dilated at 10mm. They recommended a MRI for further investigation. I have no real pain maybe occasional dull rib pain but so dull I can’t tell if it is real or psychosomatic. What could be causing this? Should I push for HIDA scan

    • Hello, elevated liver function tests may have many causes. Medication, alcohol, obesity, gallstones (either in the gallbladder or the biliary tree) hepatitis, autoimmune conditions to name a few.
      to sort this out some patient may require further studies. The size of the CBD at 10mm will be dilated if you are less than 50 or so and still have your gallbaldder. The CBD gets dilated as we age or when the gallbaldder is removed.

      MRCP will be the next test. HIDA scan will only be indicated if your ultrasound shows no stones and you give symptoms of gallstones.
      It is also interesting that you think you have psychosomatic pain and not real dull pain. Why can not the dull pain be related to gallstones, or sludge in the Gallbladder?

      • I had an ultrasound done and it stated no stones and complete normal appearance of gallbladder, and for CBD it just says 10mm. No explanation. I figured if it is stones they would have seen something in the ultrasound. The pain may be real but I struggle to even call it pain, it is maybe a dull soreness that I don’t feel often only sometimes at random times. I have been dealing with major anxiety since this started and have been all over google researching and I wonder if some of the feeling is in my head. I don’t know. I am 30yo so the CBD being dilated at 10mm scares me. Thank you for the reply.

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