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- Common bile duct narrowing and fibrosis due to chronic gallstone disease
- Stone usually impacted in gall bladder neck, cystic duct or cystic duct remnant
- Fistula can develop between gall bladder or cystic duct and common duct, stone may partially or totally pass into common duct
- Stricture commonly in upper and middle common duct
- Difficult to distinguish obstruction and thickening due to malignancy
Imaging
- Cholangiography: smooth stricture, 2-3 cm in length, often with rightward concavity
- ERCP: best demonstrates fistula