Common bile duct cyst: causes, symptoms, diagnosis, treatment

The cyst of the common bile duct is its extension. The gallbladder, the bladder duct and the hepatic ducts above the cyst are not dilated, unlike strictures, in which the entire biliary tree extends above the stricture. It is possible to combine the cyst of the common bile duct with Caroli's disease. In histological examination, the cyst wall is represented by a fibrous tissue that does not contain epithelium and smooth muscles. In patients with a common bile duct cyst, an anomaly of its fusion with the pancreatic duct (a long common segment) is described. It is suggested that cyst formation is due to reflux of the pancreatic enzymes into the bile ducts.

Cysts of common bile duct are classified as follows:

• Type I - segmental or diffuse spindle-shaped dilatation.
• Type II - diverticulum.
• Type III - choledochocele distal part of the common bile duct, mainly inside the wall of the duodenum.
• Type IV - anatomical changes characteristic of type I, are combined with a cyst of intrahepatic bile ducts (IVa, type Karoli) or with choledochocele (IVb). If the type V is isolated, it is understood as Karoli's disease.

The most common spindle-shaped extrahepatic cyst (type I), the next in frequency form - a combination of intra- and extrahepatic changes (type IVa). There is still no consensus on whether the choledochocele (type III) should be treated as a cyst.

Occasionally, isolated brushing of the intrahepatic bile ducts is observed.

The type I cyst is identified as a partially retroperitoneal cystic tumor-like formation, the dimensions of which are subject to significant fluctuations: from 2-3 cm to 8 liters reaching volume. The cyst contains a dark brown liquid. It is sterile, but can become infected again. The cyst can be torn.

In later stages, the disease can be complicated by biliary cirrhosis. Choledocha cysts can squeeze the portal vein, which leads to portal hypertension. It is possible to develop malignant tumors in the cyst or in the bile ducts. Biliary papillomatosis with a mutation of the K-ras gene is described .

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]

Symptoms of the cyst of the common bile duct

In infants, the disease manifests itself as prolonged cholestasis. Possible perforation of the cyst with the development of bile peritonitis. In older children and adults, the disease is usually manifested by transient episodes of jaundice, pains against a background of volumetric education in the abdomen. In children more often than in adults (respectively in 82 and 25% of cases), there are at least two signs from this "classical" triad. Although previously the disease was classified as a child, it is now more often diagnosed in adults. In a quarter of cases, symptoms of pancreatitis are the first manifestations. Cysts of the common bile duct more often develop in Japanese and other eastern peoples.

Jaundice is intermittent, refers to the cholestatic type and is accompanied by a fever. Pain is coliform, localized mainly in the right upper quadrant of the abdomen. The volumetric formation is caused by a cyst, it is revealed in the right upper quadrant of the abdomen, has different sizes and density.

Cysts of the common bile duct can be combined with congenital fibrosis of the liver or Caroli's disease. Important violations are bile drainage and pancreatic secretions, especially if the ducts are connected at a straight or acute angle.

Microgamartoma (von Meyenberg complexes)

Typically, microgamartomas do not appear clinically and are detected accidentally or during autopsy. Occasionally they can be combined with portal hypertension. Perhaps a combination of microgamartoma with medullary spongy kidneys, as well as with polycystosis.

Histologically, the microgamarthoma consists of a cluster of bile ducts lined with a cubic epithelium, often containing condensed bile in the lumen. These biliary structures are surrounded by a stroma consisting of mature collagen. They are usually localized within or near the portal tracts. The histological picture resembles congenital fibrosis of the liver, but has a localized character.

Methods of visualization

On arteriograms of the liver with multiple microgamartomas, the arteries look stretched, the vascular pattern in the venous phase is strengthened.

Carcinoma as a complication of polycystic disease

Tumors can develop with microgamarthomas, congenital liver fibrosis, Caroli's disease, a common bile duct cyst. With nonparasitic cysts and polycystic liver, carcinoma develops rarely. The probability of malignant degeneration increases in areas where the epithelium contacts the bile.

[12], [13], [14], [15], [16], [17], [18], [19], [20], [21]

Diagnosis of the cyst of the common bile duct

With a survey radiography of the abdominal cavity, soft tissue formation is revealed. In infants, when scanning with iminodiacetate derivatives or with ultrasound, the cyst can sometimes be detected in utero or in the postpartum period. In older children and adults, the cyst is identified with ultrasound or CT. All diagnostic methods can give a false negative result. The diagnosis is confirmed with percutaneous or endoscopic cholangiography.

[22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33]

Treatment of cyst of common bile duct

In connection with the risk of developing adenocarcinoma or squamous cell carcinoma, the method of choice is excising the cyst. Drainage of the bile is restored with the help of choledochojunostomy with the application of anastomosis with the loop of the intestine turned off.

The imposition of an anastomosis cyst with a gut without its excision is simpler, but cholangitis often develops after the operation, and later strictures of the ducts are formed and stones are formed. There is a risk of developing carcinoma, possibly associated with dysplasia and metaplasia of the epithelium.