Biliary Cystic Duct Syndrome refers to a clinical syndrome characterized primarily by biliary colicky pain, caused by mechanical non-calculous partial obstruction of the cystic duct, leading to impaired gallbladder emptying and elevated intraluminal pressure. This condition is also known as Partial Cystic Duct Obstruction Syndrome, Gallbladder Dysmotility Syndrome, Primary Chronic Cystic Ductitis, and Cozzolino Cystic Duct Syndrome.

bubble_chart Etiology

The causes of the disease include congenital and acquired factors, with acquired factors being more common. These include chronic inflammation and fibrosis of the cystic duct, twisting of the cystic duct, band-like strictures of the cystic duct, and adhesions between the gallbladder and adjacent tissues or organs, which can form an acute angle between the fistula disease and the cystic duct, also leading to the condition. Partial obstruction of the cystic duct impedes the outflow of bile, causing bile retention in the gallbladder and an increase in intra-gallbladder pressure, which in turn leads to a series of clinical symptoms.

bubble_chart Clinical Manifestations

The main manifestations include paroxysmal pain in the right upper abdomen or right hypochondrium, often colicky in nature, which may radiate to the right shoulder and back. The pain is frequently triggered by meals, especially after consuming fatty foods or overeating, and can sometimes be induced by physical exertion or emotional stress. It is often accompanied by digestive symptoms such as nausea and vomiting, and these symptoms may persist for several weeks to years. Generally, there is no shivering, fever, or jaundice.

The routine blood test showed normal white blood cell count, differential count, and liver function tests. Duodenal bile drainage revealed delayed appearance of B bile, which only flowed out 6-20 minutes after cholecystokinin stimulation, with a small amount and prolonged duration. Oral cholecystography showed good gallbladder filling but delayed emptying, with the gallbladder still visible after 36 hours. It also revealed narrow, tortuous, and elongated changes in the cystic duct, with faint or non-visualization of the common bile duct. After intravenous CCK injection, the gallbladder volume decreased by no more than 45%. ^99mTc-HIDA nuclear biliary scanning showed delayed gallbladder emptying for more than 4 hours.

bubble_chart Diagnosis

1. There is postprandial biliary colicky pain or discomfort in the right upper abdomen, but no chills, high fever, jaundice, or elevated white blood cells.

2. Oral cholecystography or radionuclide biliary scanning shows good gallbladder filling, but delayed emptying and changes in the cystic duct.

3. Examinations such as B-ultrasound, CT, and X-ray cholecystography reveal no gallbladder stones or space-occupying sexually transmitted disease lesions.

bubble_chart Treatment Measures

The most effective treatment is surgery, which may involve cholecystectomy or choledochoplasty. General treatment includes a low-fat diet, avoiding overeating, and preventing biliary tract infections. For biliary colic attacks, antispasmodics such as atropine or nitroglycerin can be used.

bubble_chart Differentiation

Differentiate from chronic cholecystitis, cholelithiasis, and adenomyomatosis of the gallbladder.