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Biliary pain is most frequently caused by obstruction of the common bile duct or the cystic duct by a gallstone. However, the presence of gallstones is a frequent incidental finding and does not always necessitate treatment, in the absence of identifiable disease.
Impacted gallstone in the cystic duct is obstructing the common hepatic duct. Mirizzi's syndrome is a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common hepatic duct, resulting in obstruction and jaundice.
Type VI: An isolated cyst of the cystic duct is an extremely rare lesion. Only single case reports are documented in the literature. The most accepted classification system of biliary cysts, the Todani classification, does not include this lesion. Cholecystectomy with cystic duct ligation near the common bile duct is curative. [5]
The cystic duct may unite with the common hepatic duct so that the common hepatic duct is either very short or very long (and the bile duct in turn very long or very short, respectively), [4] or it may instead unite with the a hepatic duct. [3] Occasionally, the cystic duct may first run alongside the common hepatic duct for some distance [2 ...
The first symptoms typically include fever, intermittent abdominal pain, and an enlarged liver.Occasionally, yellow discoloration of the skin occurs. [4] Caroli disease usually occurs in the presence of other diseases, such as autosomal recessive polycystic kidney disease, cholangitis, gallstones, biliary abscess, sepsis, liver cirrhosis, kidney failure, and cholangiocarcinoma (7% affected). [2]
Without appropriate treatment, recurrent episodes of cholecystitis are common. [1] Complications of acute cholecystitis include gallstone pancreatitis, common bile duct stones, or inflammation of the common bile duct. [1] [8] More than 90% of the time acute cholecystitis is caused from blockage of the cystic duct by a gallstone. [1]
Courvoisier's sign occurs due to the gradual (chronic) nature of the obstruction caused by cancer (e.g. pancreatic, often located in pancreatic head, cholangiocarcinoma, etc.), which gradually causes biliary back-pressure and gradually distends the gallbladder over time, without causing acute damage, thus without causing pain.
Obstruction of the common bile duct with gallstones can sometimes be relieved by endoscopic retrograde sphincterotomy (ERS) following endoscopic retrograde cholangiopancreatography (ERCP). [54] Risks of ERCP. [55] Surgery carries risks and some people continue to experience symptoms (including pain) afterwards, for reasons that remain unclear.
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