The common bile duct is formed by the union of the common hepatic and cystic ducts and runs about 6-8 cm down to the duodenum. It descends in the free edge of the lesser omentum, passes behind the first part of the duodenum, runs through or behind the head of the pancreas and joins the main pancreatic duct at the hepatopancreatic ampulla. Its normal diameter is usually under 6-7 mm, a little more in older people and after cholecystectomy.
| Location | From the junction of the cystic and common hepatic ducts, down the hepatoduodenal ligament, behind the first part of the duodenum and through the head of the pancreas to the descending duodenum |
|---|---|
| Parts |
|
| Nerve Supply | Hepatic plexus; Vagus nerve |
| Blood Supply | Posterior superior pancreaticoduodenal artery; Right hepatic and cystic arteries; Gastroduodenal artery branches |
| Venous drainage |
|
| Lymphatic drainage |
|
Carries bile from the liver and gallbladder to the duodenum.
Stones passing into the common bile duct cause obstructive jaundice, cholangitis or pancreatitis and are removed at ERCP. Cancer of the pancreatic head commonly blocks the intrapancreatic part, causing painless jaundice with a palpable gallbladder. The duct's blood supply runs along its sides at roughly the 3 and 9 o'clock positions, so stripping it during surgery can cause ischaemic strictures.
Gallstones in the common bile duct causing pain, jaundice and abnormal liver tests, usually cleared by ERCP.
Bacterial infection of an obstructed bile duct presenting with fever, jaundice and right upper quadrant pain; needs urgent drainage.
Congenital dilatation of the bile duct that can cause pain, jaundice and pancreatitis and carries a cancer risk.
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