Cystic dilatation of common bile duct. Case report and review

Abstract

The cystic dilatation of the common bile duct is a rare disease in Europe and in the USA; even rarer in adults. In fact less than 30% of cases are described in the over 20ies. There are some reports in the elderly. When observed in adults the diagnosis is usually due to the onset of symptoms of associated pathologies or to complications such as cholangitis or cancer.

Ultrasound, CT and ERCP allow, in the majority of cases, an adequate pre-operative characterization of the lesion.

Intra-operative cholangiography verifies the completeness of surgery – always resective – and excludes residual biliary pathologies. The treatment in patients who already underwent conservative surgery is more complex, in fact, in symptomatic patients a second observation and resection is mandatory while in asymptomatic patients a careful and complete follow-up is adequate without underestimating the cancer risk.

Septic and inflammatory complications, especially if chronic or recurring, can damage the liver; here resection or liver transplantion can be necessary.

The case here reported is a 24 year old woman with recurring cholangitis for at least 2 years in which US, CT and ERCP showed a Todani’s type I cystic dilatation of the CBD. The total excision of the cyst with hepatic-jejunal anastomosis was carried out. A two-year follow up demonstrated no symptoms and normal laboratory findings; cholangioscintigraphy showed a good hepatic-biliary and anastomotic function.