A choledochal cyst is a pathologically distended section 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, but 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, including inflammation of the pancreas and rupture of the cystic cavity.
Types and factors of development of this pathology
The classification of choledochal cysts in adults and children into acquired and congenital is considered controversial, since a number of scientific researchers classify all such neoplasms as primary, others admit acquired types of cysts. The following differentiation of pathological neoplasms, based on their localization and shape, is generally recognized:
- type 1 - the cyst is characterized by an expansion of the common duct(diffuse), or one of its segments (segmental, as a rule, at the point of inflection), generally spindle-shaped;
- type 2 - choledochal diverticulum, which looks like a separate vesicle;
- type 3 - diverticulum of the distal common duct;
- type 4 - identical to the first, but supplemented by cystic formations inside the hepatic ducts;
- type 5 - common ducts almost unchanged, intrahepatic ducts have some cystic abnormalities;
- FF is a type that is characterized by minor changes in the common bile duct and cystic intrahepatic lesions.
Most common cysts
The most common cyst types 1 and 4. The walls of the pathological formation are formed by connective (fibrous) tissue. It does not have smooth muscle cells and epithelium. From the inside, such a cavity is filled with a brownish liquid, initially sterile. There is also the so-called giant choledochal cyst, which is spindle-shaped and very large.
Main causes of this pathology
Among the many assumptions about the causes of choledochal cysts, two main ones can be distinguished:
- All cysts of types 1 and 4 are caused by the penetration of pancreatic enzymes into the choledochus, which cause inflammation and weakness of the walls, and increased pressure in the duct aggravates the situation.
- A choledochal cyst in childhood can be congenital or acquired (round or fusiform), in adult patients it is secondaryare worn by all pathological formations.
Thus, cysts in adulthood can develop against the background:
- abnormal duct connection;
- pathway damage in cholelithiasis;
- dysfunction of the sphincter of Oddi.
Concomitant cysts of the common duct, duodenal atresia and other pathologies that occur in the prenatal period testify in favor of the congenital nature of the occurrence of cysts.
Clinical symptoms of this disease
Choledochal cyst in 70% is diagnosed in children under 12 years old. Also, this disease is several times more common in women.
In infants, the variability in the manifestations of pathology is more noticeable. Sometimes there may be no signs of the disease, and in some cases, signs of prolonged stagnation of bile and a palpable neoplasm can be detected. Other signs include:
- jaundice of skin and mucous membranes;
- light chair;
- dark colored urine;
- heaviness or pain in the right hypochondrium, which can increase to colic and radiate to the right side of the body.
Children with a choledochal cyst at an older age may experience the following symptoms:
- jaundice - in the form of attacks or constant;
- abdominal pain;
- palpable neoplasm in the abdominal cavity.
Manifestations of cysts in adults
In adults, symptoms are often combined withsome complications of the pathological process (stagnation of bile, calculi in the gallbladder, infections and inflammation). It includes:
- persistent or episodic abdominal pain;
- fever;
- nausea and vomiting;
- mechanical jaundice.
The same signs, which are often accompanied by weight loss, may indicate malignant transformation of the cyst.
Methods for diagnosing this pathology
The basis for the detection of cysts are the patient's complaints or attacks of pancreatitis of unknown origin. On examination, the doctor may notice yellowness of the skin and sclera and palpate a tumor-like neoplasm in the right hypochondrium. Next, it is necessary to differentiate the cystic formation of the choledoch from cholelithiasis, stricture, pancreatic cysts or oncological tumors of the duct.
This is done using the following diagnostic tests:
- Ultrasound (transabdominal ultrasonography), which is effective, but does not always accurately determine the size of the cyst;
- endoscopic ultrasonography, which allows visualization of the gallbladder ducts and is not sensitive to interference in the form of subcutaneous fat or gas;
- dynamic cholescintigraphy, which is performed using a radiopharmaceutical, and has a 100% efficiency in type 1 cysts, but is unable to visualize intrahepatic deformities. Indicated in infants to detect primary disordersducts;
- CT, which is ahead of ultrasound in terms of information content and makes it possible to exclude malignant processes;
- Percutaneous, intraoperative and retrograde endoscopic cholangiography - help to obtain information about the structure of the biliary tract, including before surgery. The disadvantages of this study are invasiveness, contraindications and complications, as well as the need for general anesthesia (when examining a child);
- Magnetic resonance cholangiopancreaticography is the most effective in detecting choledochal neoplasms, easy to perform, non-invasive, somewhat inferior in sensitivity 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 disease
Do I need surgery for a choledochal cyst in children and adults?
It is possible to normalize the outflow of bile during the formation of pathology only by surgery. There are three options for surgical interventions:
- Creating an artificial anastomosis of a pathological formation with the 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 tissue degeneration.
- Complete excision of the neoplasm followed by connection with the small intestine. Such an operation can be carried outby abdominal 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 surgery for choledochal cyst is chosen, the occurrence of complications depends mainly on the identified stage of the pathological process. Therefore, if there are symptoms with the diagnosis of a cyst and surgical treatment, you should not hesitate.
Complications
Even if the cyst does not cause much concern, it disrupts the outflow of bile, causing the development of inflammation and the formation of calculi, which is manifested by the following pathologies:
- cholangitis - inflammation of the common bile duct;
- calculous cholecystitis;
- pancreatitis - a complex of symptoms of the inflammatory process in the pancreas;
- rupture of the cyst, accompanied by symptoms of "acute abdomen" or blood poisoning;
- gallstone disease;
- portal hypertension, which develops against the background of liver damage or compression of the portal vein cyst;
- secondary cirrhosis;
- degeneration of a cyst into cholangiocarcinoma - an oncological neoplasm in the bile ducts;
- compression of the duodenum that causes obstruction.
Removal of a choledochal cyst can also have a number of negative consequences. This applies in most cases of surgical operations without resection or manipulation innewborns.
Prevention
Preventive measures consist of careful attention to the problems of the digestive process and modern examinations by a specialist.
It is also very important to provide treatment for gastrointestinal pathologies, the signs of which may mask a cystic neoplasm.
