Symptoms of bile duct dilatation

summary

Choledochectasis is a common congenital biliary malformation, which was previously considered to be a lesion confined to the common bile duct, so it is called congenital choledochal cyst. This disease was first reported by Vater in 1723. In 1852, Douglas described its symptomatology and pathology in detail. For more than a century, with the deepening of the understanding of this disease, in recent years, cholangiography found that dilated lesions can occur in any part of the intrahepatic and extrahepatic bile duct. According to the morphology and number of the parts, there are many types, and the clinical manifestations are also different. Symptoms of bile duct dilatation? Let's talk about it

Symptoms of bile duct dilatation

Abdominal mass, abdominal pain and jaundice are considered as the classic triple symptoms of cholangiectasis. The abdominal mass is located in the right upper abdomen, under the costal margin, and the huge one can occupy the whole right abdomen. The mass is smooth and spherical, and can have obvious elastic sensation of cyst. When the cyst is full of bile, it can show a solid feeling, like a tumor. But there are often changes in size, in infection, pain, jaundice attack period, the mass increased, symptoms relieved, the mass can be slightly reduced.

Small bile duct cyst, because the location is very deep, is not easy to palpate. Abdominal pain occurs in the middle part of the upper abdomen or right upper abdomen. The nature and degree of pain are different. Sometimes it is persistent distending pain, sometimes colic. The patient often takes a prone position with knees bent and refuses to eat to relieve symptoms.

Symptoms often accompanied by blood and urine amylase value increased. Jaundice is mostly intermittent, often the main symptom of children. The depth of jaundice is directly related to the degree of biliary obstruction. Mild patients may not have jaundice clinically, but with infection and pain, jaundice may appear temporarily, the color of feces becomes light or gray, and the color of urine is deep. The above symptoms were intermittent. Because the distal outlet of bile duct is not unobstructed, pancreaticobiliary reflux can cause clinical symptoms. When the bile can be discharged smoothly, the symptoms will be relieved or disappeared. Interval attack time varies, some attack frequently, some long-term asymptomatic.

matters needing attention

Once the diagnosis is made, surgical treatment should be taken. The operation is nothing more than drainage and resection. In principle, resection should be used for diverticulum type and duodenal choledochocele type; Only in the common type, because the cyst is too large, it is difficult to remove, which may damage the surrounding important tissues, or in the stage of acute infection, only drainage is adopted. There are two kinds of drainage: external drainage and internal drainage. External drainage is easy to cause hypotonic dehydration, acidosis and electrolyte disorder. Therefore, in emergency operation, only when the infection is serious or the general condition is too bad, can we intubate the gallbladder or suture the cyst bag. After the general condition is improved, we can establish the bilioenteral access. Internal drainage includes cystoduodenostomy, cystogastrostomy and Cystojejunostomy, but it is easy to cause gastrointestinal reflux, leading to ascending cholangitis. It is suggested that the greater curvature of the stomach should be made into a tube and then anastomosed with the cyst; It is more common to perform Roux cyst jejunal Y-type anastomosis, using a 30 cm long, nonfunctioning intestinal tube to do end-to-end anastomosis with the cyst, 70% - 80% of the cases can achieve satisfactory results.