Gallgångsdilation

Gallgångsdilation, also known as biliary dilatation, refers to the widening of the biliary ducts due to obstruction, inflammation, or other disease processes. It is not a disease in itself but a finding that indicates cholestasis or impaired bile flow. The dilation may involve either the intrahepatic or extrahepatic ducts, or both.

Common causes include choledocholithiasis (stones in the common bile duct), malignant obstruction (such as pancreatic head cancer or cholangiocarcinoma), benign biliary strictures (postoperative or inflammatory), primary sclerosing cholangitis, and pancreatitis. Less frequent causes include congenital anomalies like choledochal cysts and, in endemic areas, parasitic infections. Dilatation can be an acute or chronic finding depending on the underlying process.

Clinical presentation varies with cause but may include jaundice, pruritus, dark urine, pale stools, and right upper quadrant discomfort. Cholangitis, a potential complication, presents with fever, jaundice, and abdominal pain and requires urgent management.

Diagnosis typically begins with ultrasound, which can show dilated intrahepatic and/or extrahepatic ducts. MRCP (magnetic resonance cholangiopancreatography) provides a noninvasive map of the biliary tree. Laboratory tests often reveal a cholestatic pattern (elevated alkaline phosphatase and bilirubin). Endoscopic retrograde cholangiopancreatography (ERCP) is used for both diagnosis and treatment, allowing stone extraction, stenting, or biopsy, while CT or other imaging may be employed to evaluate surrounding structures.

Management focuses on treating the underlying cause and relieving obstruction. This may involve ERCP-based stone removal or stenting, antibiotics for cholangitis, or oncologic or surgical interventions for malignant obstruction. The prognosis depends on timely relief of biliary obstruction and the underlying disease.