CYSTIC DISEASE OF BILE DUCTS: DIFFERENTIAL DIAGNOSTICS AT THE STAGES OF SURGICAL TREATMENT

Aim. To evaluate the role of radiological methods in diagnosis and differential diagnosis of cystic transformation of bile ducts and monitoring of operated patients.

Material and Methods. The study included 38 patients with cystic transformation of bile duct aged 25–75 years (mean 41.1 ± 13.5 years). There were 6 (16%) men and 32 (84%) women. Preoperative survey included ultrasound, CT, MRI, ERCP. All patients were operated.

Results. All patients were divided into 2 groups: group 1 consisted of 17 (44.7%) patients with primary disease, group 2 – 21 (55.3%) patients with previous surgery for biliary cysts. Cystic transformation was not eradicated almost in all cases that resulted symptoms in remote period. Computed tomography was excluded from the diagnostic algorithm in view of these data. Therefore, cost and time of examination were reduced. The most effective diagnostic protocol for cystic transformation of bile duct includes ultrasound, contrast-enhanced MRI. These methods cover all necessary diagnostic spectrum and define the diagnosis in almost 98–100% of cases.

Conclusion. An assessment of cystic transformation of bile ducts should include following parameters: cyst type by T. Todani classification, state of its wall and content, relationship with surrounding organs and their structural changes. These parameters are important to choose the right surgical approach. These data should be obtained at preoperative stage. It is essential to begin a survey from non-invasive methods. High risk of long-term postoperative complications and malignant transformation indicates the need for dynamic monitoring of patient after surgery. 

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