There are two types of bile duct stones: primary and secondary. Primary bile duct stones are stones that originate in the biliary system (including intrahepatic and extrahepatic bile ducts), while secondary bile duct stones are stones that originate in the gallbladder and enter and remain in the common bile duct through the cystic duct. The clinical symptoms of extrahepatic bile duct stones depend on whether the stones obstruct the bile duct and on the degree of secondary infection. When the stone does not obstruct the bile duct and there is no biliary infection, there are usually no obvious symptoms, or occasionally there are atypical symptoms such as postprandial epigastric discomfort, intermittent right upper abdominal pain, dyspepsia, and occasional low-grade fever. When stones obstruct the bile ducts, jaundice, infection and/or acute cholangitis may occur. Most of them will first present with severe pain or colic in the upper abdomen, often accompanied by nausea and vomiting, followed by chills, high fever and jaundice, in a classic Charcot triad, which can recur. In severe cases of infection, hypotension, toxic shock, and even confusion and coma may be seen in acute obstructive septic cholangitis. A small number of patients with bile duct obstruction but no concurrent infection may have only varying degrees of pain, jaundice or painless fluctuating jaundice. Intrahepatic bile duct stones often coexist with extrahepatic bile duct stones, and most patients have the clinical manifestations of extrahepatic bile duct stones. The diagnosis of choledocholithiasis is generally not difficult in patients with typical Charcot’s triad, especially those with a previous history of gallbladder stones.