Bile Duct Stones & Cholangitis in Singapore

Written & reviewed by the BestDoctors.sg editorial team · Last updated 1 Sep 2026 · General information, not medical advice

A stone in the bile duct is more than a painful nuisance – because it blocks bile, it can lead to a life-threatening infection. Recognising the fever-jaundice-pain combination is what gets people to emergency treatment in time.

What they are

Bile is a fluid made by the liver that helps digest fat. It flows from the liver and gallbladder down a narrow tube called the common bile duct into the small intestine. Bile duct stones (the medical term is choledocholithiasis) are stones sitting inside this duct. Most begin as gallstones that form in the gallbladder and then migrate down into the bile duct; less commonly, stones form in the duct itself, particularly when bile has been draining poorly for a long time. Because the bile duct is the main drainage channel for bile, a stone lodged there can partly or completely block the flow – and a blocked, stagnant duct is what turns a mechanical problem into a dangerous one. If trapped bile becomes infected, the result is cholangitis, a serious and potentially life-threatening infection of the bile duct.

Symptoms

A blocked bile duct backs bile up into the bloodstream, and the pattern of symptoms reflects this:

• Abdominal pain – typically in the upper abdomen, often on the right side or in the centre, and it may come in waves or radiate to the back.
• Jaundice – yellowing of the skin and the whites of the eyes.
• Dark urine and pale, clay-coloured stools – because bile pigment that normally colours the stool is diverted into the urine instead.
• Itchy skin – a common effect of bile products building up in the blood.
• Nausea and vomiting, and a general loss of appetite.

Some small stones pass on their own and cause only brief symptoms, or none at all. The warning sign to know is what happens when infection sets in: cholangitis classically adds fever with shaking chills on top of the pain and jaundice. This combination – pain, fever and jaundice together, known as Charcot’s triad – is a red flag that should send you to hospital straight away. In more severe infection, low blood pressure and confusion may be added, indicating the body is tipping into sepsis.

Causes and who is at risk

The underlying cause is nearly always gallstones, so the risk factors overlap with those for gallstones in general. These include older age, previous gallbladder problems or known gallstones, and having had gallstone-related symptoms before. People who still have their gallbladder in place after a stone episode, and those with narrowed or previously operated bile ducts, are also more likely to develop stones in the duct. A family history of gallstones, being overweight, rapid weight loss, and certain conditions affecting how bile is made can all raise the background risk of gallstones that may then migrate. Bile duct stones can also appear years after the gallbladder has been removed, if a stone was left behind or forms anew.

How it is diagnosed

Diagnosis combines blood tests with imaging:

• Blood tests – liver function tests often show a “blockage” pattern that points to an obstructed duct, and other blood markers can indicate infection when cholangitis is present.
• Abdominal ultrasound – usually the first scan; it looks at the gallbladder and can show a dilated (widened) bile duct, though small duct stones are easily missed.
• MRCP (magnetic resonance cholangiopancreatography) – a non-invasive MRI that produces detailed pictures of the bile ducts and is very good at finding stones the ultrasound cannot see.
• Endoscopic ultrasound (EUS) – a scan taken from inside the gut using a scope, useful for detecting small stones near the lower end of the duct.
• ERCP (endoscopic retrograde cholangiopancreatography) – a specialised procedure that can both confirm a stone and treat it in the same session, so it is often used when a stone is strongly suspected and likely to need removal.

Complications

Left untreated, a blocked bile duct can lead to several serious problems:

• Cholangitis and sepsis – infection of the trapped bile can spread into the bloodstream, causing a body-wide, life-threatening reaction. This is the most urgent complication.
• Gallstone pancreatitis – a stone passing near where the bile and pancreatic ducts join can inflame the pancreas, causing severe upper-abdominal pain that spreads to the back. Pancreatitis can itself become serious.
• Liver problems – prolonged obstruction puts strain on the liver and, over time, can damage it.

Treatment

Bile duct stones, and especially cholangitis, often need urgent hospital care. Treatment has two aims: control the infection and clear the blockage.

• Antibiotics and fluids – given without delay when cholangitis is present, to treat the infection and support blood pressure while the duct is cleared.
• A procedure to remove the stone and drain the duct – usually ERCP. During ERCP, a scope is passed to the opening of the bile duct, a small cut is made to widen it (sphincterotomy), and the stone is pulled out or a small tube (stent) is placed to restore drainage. Relieving the blockage is what allows the infection to settle.
• Removing the gallbladder – once the duct is clear and the person has recovered, cholecystectomy (keyhole removal of the gallbladder) is generally recommended to prevent further stones forming and migrating. This is usually planned as a separate step.

Most people recover well once the duct is cleared and any infection is treated. In Singapore, this care is delivered in hospital by a gastroenterologist and, for surgery, a hepatobiliary or general surgeon.

Prevention and after treatment

Because bile duct stones almost always come from gallstones, the main way to prevent a recurrence is to remove the gallbladder after the duct has been cleared, as advised by your specialist. After ERCP and, later, gallbladder removal, most people return to normal digestion – the liver continues to make bile, which simply drains directly into the gut. General measures that lower gallstone risk, such as maintaining a healthy weight, avoiding very rapid weight loss, and eating a balanced diet, are sensible for long-term health. Keep any follow-up appointments, and report any return of pain, fever or jaundice promptly, as stones can occasionally recur or be left behind. Reliable, plain-language information on gallstones and bile duct problems is available from HealthHub, Singapore’s national health portal.

When to see a doctor

See a doctor – a GP or a gastroenterologist – if you have episodes of upper-abdominal pain, unexplained nausea, yellowing of the skin or eyes, dark urine or pale stools, or itchy skin, so the cause can be assessed and treated before it worsens.

Go to A&E or call 995 immediately if you have any of the following:

• Tummy pain, fever or chills, and jaundice together – this combination may be cholangitis, a medical emergency.
• Severe, unrelenting upper-abdominal pain, especially with a high fever.
• Confusion, drowsiness, or feeling very unwell.
• Persistent vomiting, vomiting blood, or black tarry stools.

Related digestive & liver conditions

• Barrett’s oesophagus
• Oesophageal cancer
• Hiatus hernia
• Gastroparesis (delayed emptying)
• Lactose intolerance
• Colon polyps
• Jaundice in adults
• Alcohol-related liver disease
• Abnormal liver function tests
• Acid reflux & GERD
• Gallstones
• Gastroenterologists in Singapore
• Bile Duct Cancer (Cholangiocarcinoma) in Singapore
• ERCP

Sources

• SingHealth / NUH, Singapore — stones in the bile duct and ERCP (stones migrate from the gallbladder; jaundice/cholangitis/pancreatitis; ERCP + antibiotics + later cholecystectomy).
• Merck Manual — choledocholithiasis and cholangitis (Charcot’s triad; ascending infection; ERCP as treatment).
• StatPearls (NIH) / NHS inform — diagnosis (ultrasound/MRCP/EUS); ERCP with sphincterotomy; gallstones as the underlying risk factor.