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Biliary Cyst – Causes, Symptoms & Treatment

A biliary cyst is a fluid-filled sac that forms in or around the bile ducts or liver. It may be congenital or acquired and should be evaluated by a doctor depending on its size and symptoms.

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Things worth knowing about "Biliary Cyst"

A biliary cyst is a fluid-filled sac that forms in or around the bile ducts or liver. It may be congenital or acquired and should be evaluated by a doctor depending on its size and symptoms.

What Is a Biliary Cyst?

A biliary cyst (also called a bile duct cyst or choledochal cyst) is a fluid-filled cavity that develops within or adjacent to the bile ducts or liver. These cysts can be present from birth (congenital) or develop later in life (acquired). They vary greatly in size and clinical significance, ranging from small, incidental findings to large cysts that cause symptoms or serious complications.

Causes

The exact causes of biliary cysts are not always clearly understood. The following factors are associated with their development:

Congenital malformations: Developmental abnormalities of the bile ducts during fetal development are the most common cause of congenital biliary cysts.
Choledochal cysts: A specific type of congenital biliary cyst involving cystic dilation of the common bile duct. They are classified into five types according to the Todani classification.
Inflammatory conditions: Chronic inflammation of the bile ducts, such as in primary sclerosing cholangitis, can contribute to cyst formation.
Parasitic infections: In certain regions, parasites such as Echinococcus (tapeworm) can cause liver cysts that mimic biliary structures.
Trauma or surgery: Abdominal injuries or previous surgical procedures may occasionally lead to acquired cyst formation.

Symptoms

Many biliary cysts are entirely asymptomatic and are discovered incidentally during an ultrasound examination. When symptoms occur, they may include:

Right-sided upper abdominal pain or pressure
Nausea and vomiting
Jaundice (icterus) caused by obstruction of the bile ducts
Pale stools and dark urine (indicating bile flow obstruction)
Fever if the cyst becomes infected or inflamed
A palpable mass in the upper abdomen (in cases of large cysts)

Diagnosis

Biliary cysts are typically diagnosed using imaging techniques:

Ultrasound (sonography): Usually the first diagnostic step; shows the cyst as a hypoechoic (fluid-filled) structure.
MRI / MRCP: Magnetic resonance cholangiopancreatography (MRCP) provides detailed visualization of the bile ducts without radiation exposure.
Computed tomography (CT): Used for precise localization and to assess potential complications.
Endoscopic retrograde cholangiopancreatography (ERCP): Can serve both diagnostic and therapeutic purposes.
Blood tests: Liver enzymes (e.g., bilirubin, alkaline phosphatase, GGT) and inflammatory markers help assess biliary involvement.

Treatment

Treatment depends on the size, type, and symptoms associated with the biliary cyst:

Watchful Waiting

Small, asymptomatic cysts with no signs of malignancy or complications may be monitored regularly with follow-up ultrasound examinations without immediate intervention.

Endoscopic Treatment

In certain cases, an endoscopic approach via ERCP may be used, for example by placing a stent or draining the cyst.

Surgical Treatment

Larger, symptomatic, or complication-prone cysts require surgical intervention. For choledochal cysts, complete surgical removal (resection) followed by biliodigestive anastomosis is considered the gold standard, given the elevated risk of malignant transformation.

Percutaneous Drainage

In some situations, ultrasound- or CT-guided puncture and drainage of the cyst may be performed, especially for infected or symptomatic cysts.

Complications

Untreated or large biliary cysts may lead to serious complications, including:

Bile flow obstruction (cholestasis) with jaundice
Inflammation of the bile ducts (cholangitis)
Pancreatitis (inflammation of the pancreas)
Spontaneous rupture of the cyst
Malignant transformation (particularly in choledochal cysts)

References

Todani T. et al. - Congenital bile duct cysts: Classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. American Journal of Surgery, 1977.
Singham J., Yoshida E. M., Scudamore C. H. - Choledochal cysts: Part 1 of 3: Classification and pathogenesis. Canadian Journal of Surgery, 2009.
European Association for the Study of the Liver (EASL) - EASL Clinical Practice Guidelines on the management of cystic liver diseases. Journal of Hepatology, 2022.

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