The cyst of the common bile duct is a pathologically stretched area of the bile duct, resembling a sac. Whether this pathology is only congenital (primary) or may have an acquired form - there is still no unequivocal opinion on this matter.
This type of pathological neoplasm is not very common, however, it is not worth excluding it as the cause of unpleasant symptoms in adults and children, as well as exposing yourself to the likelihood of developing complications, among which are inflammation of the pancreas and rupture of the cystic cavity.
Types and development factors of this pathology
The classification of choledochal cysts in adults and children into acquired and congenital is considered controversial, because a number of scientific researchers attribute all such neoplasms to primary, others allow acquired types of cysts. The following differentiation of pathological neoplasms based on their localization and shape is universally recognized:
- type 1 - the cyst is characterized by the expansion of the common duct (diffuse), or one of its segments (segmental, usually at the inflection point), generally having a fusiform shape;
- type 2 - diverticulum of the common bile duct, which looks like a separate bubble;
- type 3 - diverticulum of the distal parts of the common duct;
- type 4 - identical to the first, but supplemented by cystic formations inside the hepatic ducts;
- type 5 - common ducts are almost unchanged, some cystic abnormalities have intrahepatic;
- FF is a type that is characterized by a minor change in the common bile duct and cystic intrahepatic lesions.
Most common cysts
The most common cysts are types 1 and 4. The walls of the pathological formation are formed by connective (fibrous) tissue. She has no smooth muscle cells and epithelium. Inside, such a cavity is filled with a brownish liquid, originally sterile. There is also the so-called giant cyst of the common bile duct, which has a fusiform shape and very large sizes.
The main causes of this pathology
Among the many assumptions about the causes of choledoch cysts, two main ones can be distinguished:
- All cysts of types 1 and 4 are caused by the penetration of pancreatic enzymes into the common bile duct, which cause inflammation and weakness of the walls, and increased pressure in the duct exacerbates the situation.
- The common bile duct cyst in childhood can be congenital or acquired (round or spindle-shaped), in adult patients all pathological formations are secondary.
Thus, cysts in adulthood can develop against the background of:
- abnormal connection of ducts;
- damage to the pathways with cholelithiasis;
- dysfunctions of the sphincter of Oddi.
Concomitant cysts of the common duct, atresia of the duodenum and other pathologies that occur in the prenatal period are evidence of the congenital nature of the appearance of cysts.
Clinical symptoms of this disease
Cyst of the common bile duct in 70% is diagnosed in children under 12 years of age. Also, this disease is several times more likely to occur in women.
In infants, the variability of the manifestations of the pathology is noticeable more strongly. Sometimes signs of the disease may be absent, and in some cases, signs of prolonged stagnation of bile and palpable neoplasm can be detected. Other symptoms include:
- yellowness of the skin and mucous membranes;
- light stool;
- dark urine;
- heaviness or pain in the right hypochondrium, which can increase to colic and give to the right side of the body.
In children with a cyst of the common bile duct at an older age, the following symptoms may appear:
- jaundice - in the form of seizures or constant;
- stomach ache;
- palpable neoplasm in the abdominal cavity.
Manifestations of cysts in adults
In adults, the symptoms are often combined with some complications of the pathological process (stagnation of bile, calculi in the gallbladder, infections and inflammatory phenomena). It includes:
- persistent or episodic abdominal pain;
- fever
- nausea and vomiting
- obstructive jaundice.
The same signs, which are often supplemented by weight loss, can indicate a malignant transformation of the cyst.
Diagnostic methods for this pathology
The basis for the detection of cysts is the patient’s complaints or attacks of pancreatitis of unknown origin. Upon examination, the doctor may notice yellowness of the skin and sclera and palpate a tumor in the right hypochondrium. Next, it is necessary to differentiate the cystic formation of the common bile duct from cholelithiasis, stricture, cysts of the pancreatic or oncological tumor of the duct.
This is done using the following diagnostic tests:
- Ultrasound (transabdominal ultrasonography), which is effective, but does not always allow accurate determination of the size of the cyst;
- endoscopic ultrasonography, which makes it possible to visualize the ducts of the gallbladder and is not sensitive to interference in the form of subcutaneous fat or gas formation;
- dynamic cholecintigraphy, which is carried out using a radiopharmaceutical, and has 100% efficiency for cysts of the first type, but is not able to visualize intrahepatic deformities. Indicated for infants to identify primary duct dysfunctions;
- CT scan, which is ahead of ultrasound in terms of information and makes it possible to exclude malignant processes;
- Percutaneous, intraoperative and retrograde endoscopic cholangiography - help to obtain information about the structure of the bile ducts, including before surgery. The disadvantages of this study are invasiveness, contraindications and complications, as well as the need for general anesthesia (during examination in a child);
- Magnetic resonance cholangiopancreatography - the most effective in detecting neoplasms of the common bile duct, easy to conduct, non-invasive, in sensitivity slightly inferior to ERCP.
In general, diagnostic measures begin with ultrasound, and then the examination depends on the type of cyst, the technical equipment of the medical institution and the complexity of the upcoming surgical treatment.
Therapy of ailment
Is operation for choledochal cyst in children and adults necessary?
Normalizing the outflow of bile during the formation of pathology is possible exclusively by surgery. There are three options for surgical interventions:
- The creation of an artificial anastomosis of a pathological formation with a duodenum without resection of the cystic cavity is the least radical technique, the disadvantages of which are the likelihood of postoperative complications, exacerbations and oncological degeneration of tissues.
- Complete excision of the neoplasm with subsequent connection to the small intestine. Such an operation can be performed by a cavity or laparoscopic method.
- External bile drainage, which is used only in exceptional cases and is an additional measure that improves the patient's well-being before surgery.
Whatever method of operation for a choledochal cyst is chosen, the occurrence of complications depends mainly on the identified stage of the pathological process. Therefore, if there are symptoms with diagnosis of cysts and surgical treatment, you should not hesitate.
Complications
Even if the cyst does not cause particular concern, it disrupts the outflow of bile, causing inflammation and the formation of calculi, which is manifested by the following pathologies:
- cholangitis - inflammation of the common bile duct;
- stoneless cholecystitis;
- pancreatitis - a complex of symptoms of the inflammatory process in the pancreas;
- rupture of the cyst, accompanied by symptoms of an “acute abdomen” or blood poisoning;
- cholelithiasis;
- portal hypertension, which develops against a background of liver damage or compression of a portal vein cyst;
- secondary cirrhosis of the liver;
- degeneration of the cyst into cholangiocarcinoma - an oncological neoplasm in the bile ducts;
- squeezing the duodenum, which causes obstruction.
Removal of the common bile duct cyst can also have a number of negative consequences. This applies in most cases to surgical operations without resection or manipulation in newborns.
Prevention
Preventive measures are careful attention to the problems of the digestive process and modern examinations by a specialist.
It is also important to provide treatment for gastrointestinal pathologies, the signs of which can mask a cystic neoplasm.