From the Guidelines
Common bile duct (CBD) dilation is most frequently caused by gallstones that have migrated from the gallbladder into the common bile duct, causing mechanical obstruction, as well as other conditions such as pancreatic cancer, cholangiocarcinoma, and chronic pancreatitis. The causes of CBD dilation can be categorized into several groups, including:
- Mechanical obstruction caused by gallstones, which are present in approximately 10% of those with gallstone disease 1
- Compression by external forces, such as pancreatic cancer, especially tumors in the head of the pancreas, which can compress the CBD as it passes through this region
- Direct obstruction by tumors within the duct, such as cholangiocarcinoma (bile duct cancer)
- Inflammatory conditions, such as primary sclerosing cholangitis, which can cause multiple strictures 1
- Benign biliary strictures from prior surgery or trauma
- Parasitic infections, such as liver flukes in endemic areas
- Ampullary tumors that block the opening of the CBD into the duodenum Less common causes include choledochal cysts (congenital dilations), Mirizzi syndrome (external compression by gallstones), and papillary stenosis. The management of CBD dilation depends on the underlying cause, and treatment options may include endoscopic retrograde cholangiography (ERCP), laparoscopic cholecystectomy, or percutaneous stone extraction 1. Diagnosis typically requires imaging studies like ultrasound, CT, MRCP, or ERCP, with treatment directed at the underlying cause. It is essential to address CBD dilation promptly to prevent complications such as jaundice, cholangitis, or pancreatitis.
From the Research
Causes of CBD Dilation
- The causes of common bile duct (CBD) dilation can be attributed to various factors, including:
- Post-cholecystectomy status 2
- Cholelithiasis (gallstones) 2, 3
- Acute pancreatitis 2
- Passed CBD calculi (stones) 2
- Perivaterian diverticulum 2
- Viral aetiology 2
- Tumors 2
- Juxtapapillary duodenal diverticulum (JDD) 4
- Benign stricture 4
- Distal CBD mass 4
- Choledochal cyst 4
- Anomalous union of the pancreaticobiliary duct (AUPBD) 4
- CBD dilation can also occur without any apparent cause, and in such cases, it is often considered benign and of no consequence 2
- The management of CBD dilation depends on the underlying cause and may involve procedures such as endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic balloon dilation (PTBD), or surgery 5, 2, 3, 6