Overview of Gallbladder Duct Syndrome
Cholangiocele syndrome refers to a group of clinical syndromes characterized by biliary colic, caused by incomplete, noncalcific, mechanical obstruction of the cystic duct, resulting in poor bile drainage and elevated intracystic pressure. This syndrome is also known as partial obstruction of the cystic duct syndrome, gallbladder dyskinesia syndrome, and primary chronic cholecystolithiasis. In patients with choledochal duct syndrome, bile from the bile duct may slowly fill the gallbladder, but when the gallbladder is stimulated by a fatty diet or cholecystokinin, bile flow is impeded due to partial obstruction of the choledochal duct, which leads to strong but ineffective contractions of the gallbladder.
Etiology
There are congenital and acquired factors, and acquired factors are more common, such as chronic inflammation and fibrosis of the gallbladder duct, twisting of the gallbladder duct, banded narrowing of the gallbladder duct, etc. Adhesion between the gallbladder and neighboring tissues and organs can cause acute angle between the funnel part and the gallbladder duct. Due to partial obstruction of the cystic duct, bile outflow is blocked, and bile retention in the gallbladder causes an increase in intracystic pressure, leading to a series of clinical symptoms.
Symptoms
The main manifestations include paroxysmal right upper abdominal or right quadrilateral rib pain, mostly colicky pain, which may radiate to the back of the right shoulder and is often triggered by meals, especially after fatty or full meals, and sometimes can be triggered by exertion or mental stimulation. It is often accompanied by nausea, vomiting and other dyspeptic symptoms, and the symptoms may last for several weeks to several years. There are usually no chills, fever or jaundice.
Examination
Routine blood white blood cell count, classification and liver function tests are basically normal. Duodenal bile drainage, delayed appearance of B bile, after stimulation with cholecystokinin, B bile does not flow out until 6 to 20 minutes later, and the amount is small and lasts for a long time. Good filling of gallbladder after oral administration of cholecystokinetic agent, but delayed emptying, gallbladder was still visualized after 36 hours, and also showed alterations such as narrowing, twisting, and elongation of the choledochal ducts, pale or no shadow of the common bile ducts, and the volume of the gallbladder was reduced by no more than 45% after intravenous injection of cholecystokinin. 99mTc-HIDA nuclide biliary system scanning, with a delay of more than 4 hours in gallbladder emptying. b-ultrasound, CT, and x-ray cholecystograms No gallbladder stones or space-occupying lesions were found.
Diagnosis
Choledochal duct syndrome should be suspected on the basis of typical pain, absence of stones on cholangiography and good gallbladder filling, and inability to adequately empty the bile after a fatty meal, but a definitive diagnosis requires a combination of the above tests.
Differential diagnosis
Diseases that require differential diagnosis include:
1. Cholelithiasis
Patients with small gallstones in the cystic duct may resemble choledochal duct syndrome in various ways, including clinical symptoms, cholecystokinin-stimulated bile drainage, and cholangiography. Small stones located in the cystic duct may be detected during cholecystectomy or at postoperative dissection.
2. Chronic cholecystitis and gallbladder hyperplasia
Patients with nonstone chronic cholecystitis often have a nonfilling or obstructed gallbladder. Patients with cholecystic hyperplasia, especially adenomyosis, may present with pain in the gallbladder region after injection of cholecystokinin. Delayed or accelerated emptying of the gallbladder varies in patients with these disorders, and corresponding changes in the morphology of the gallbladder are easily detected on imaging. Choledochal duct syndrome can overlap with nonstruvous chronic cholecystitis and cholecystolithiasis in terms of pathophysiology, pathologic anatomy, and symptoms. Mild to moderate chronic inflammation and wall thickening of the gallbladder are common in choledochal duct syndrome; patients with cholecystolithiasis and chronic cholecystitis are also mostly symptomatic, mainly due to obstruction of gallbladder emptying and narrowing of the gallbladder neck or cystic duct.
3. Low gallbladder tone
In patients with hypotonic gallbladder, cholecystography may be well-filled due to the presence of cholecystokinin antagonists, but the gallbladder contracts poorly or fails to contract, and the injection of cholecystokinin is usually accompanied or followed by no symptoms of pain. In addition, patients with sphincter dyskinesia respond better to nitroglycerin and anticholinergic drugs.
4. Pancreatic and duodenal diseases
Organic diseases of the pancreas and duodenum, including duodenal, jugular abdominal and pancreatic tumors and pancreatitis, are not easily confused with cholangiocarpal tunnel syndrome because of their radiologic and laboratory features. Transendoscopic retrograde cholangiopancreatography and cholecystography can be performed to differentiate it if necessary.
Complications
Chronic inflammation and fibrosis of the cystic duct, twisting of the cystic duct, and banded stenosis of the cystic duct.
Treatment
The most effective treatment is surgery, either cholecystectomy or cholecystobiliary cholangioplasty. General treatment is a low-fat diet, avoidance of full meals, and prevention of biliary infections. Antispasmodics such as atropine and nitroglycerin can be used for biliary colic attacks.
Prevention
Prevent gallbladder disease by maintaining a balanced diet and taking care to eat a low-fat diet.