From the Guidelines
Closed ducts can occur due to various causes, including inflammation, infection, obstruction, or structural abnormalities, with treatment depending on the specific duct system affected. In the context of patent ductus arteriosus (PDA), a condition where the ductus arteriosus fails to close after birth, the most common cause of a closed duct is the intentional closure of the PDA through surgical or percutaneous catheter closure methods 1. Some key causes of closed ducts in different body systems include:
- Inadequate milk drainage, pressure from tight clothing, or missed feedings in the mammary system
- Gallstones, tumors, or inflammatory conditions like primary sclerosing cholangitis in the hepatobiliary system
- Stones, tumors, or chronic pancreatitis in the pancreatic ducts
- Stones (sialolithiasis) or inflammation (sialadenitis) in the salivary gland ducts
- Infection, trauma, or congenital abnormalities in the lacrimal ducts According to the most recent guidelines, device closure is the method of choice for closing a PDA, even in adults with cardiac issues 1. This approach is preferred due to the potential complications associated with surgical closure, such as calcification of the PDA, which can pose problems for surgical closure 1. Early intervention is crucial to prevent complications like infection, tissue damage, or functional impairment of the affected organ system.
From the Research
Causes of Closed Duct
The causes of a closed duct, also known as biliary obstruction, can be attributed to various factors. Some of the main causes include:
- Stones in the common bile duct, known as choledocholithiasis, which can occur in up to 20% of patients with cholelithiasis 2
- Biliary atresia, an inflammatory cholangiopathy of infancy that can result in progressive fibrosis and obliteration of extrahepatic and intrahepatic bile ducts 3
- Complications from surgical procedures, such as laparoscopic choledochotomy, which can lead to biliary complications 4
- Cystic duct leakage after laparoscopic cholecystectomy, which can be influenced by the technique used for cystic duct closure 5
Biliary Obstruction
Biliary obstruction can be caused by various factors, including:
- Choledocholithiasis, which can generate symptoms due to biliary obstruction 2
- Biliary atresia, which can progress to biliary cirrhosis, end-stage liver failure, and death if left untreated or if the Kasai procedure fails 3
- Other nonsurgical causes of neonatal cholestasis, which can have overlapping clinical, laboratory, and imaging features with biliary atresia 3
Diagnosis and Treatment
The diagnosis and treatment of closed ducts can involve various imaging methods and techniques, including:
- Ultrasound, CT, MRI, endoscopic ultrasonography, and percutaneous, intraoperative, or endoscopic retrograde cholangiography 6
- Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) for the diagnosis of choledocholithiasis 2
- Percutaneous cholecysto-cholangiography, endoscopic retrograde cholangiopancreatography, and liver biopsy for the diagnosis of biliary atresia 3
- Different techniques for cystic duct closure, such as non-locking clips, locking clips, ligatures, and harmonic energy, which can influence the risk of bile duct leakage after laparoscopic cholecystectomy 5