Ultrasound images Postsurgical CBD dilatation In patients who have had cholecystectomy associated with previous dilatation of the CBD it is common to find a persistent (but non-significant) mild dilatation of the duct postoperatively. The serum alkaline phosphatase and bilirubin levels should be normal in the absence of pathology. Because stones may be found in the duct postoperatively, it is important to differentiate non-obstructive from truly obstructive dilatation in a symptomatic patient (Fig. below). If in doubt, the patient may be rescanned at a suitable interval to assess any increase in ductal diameter.
Biliary dilatation following laparoscopic
cholecystectomy, due to a surgical clip across the CBD
Fibrosis of the duct walls There are a number of chronic pathological conditions which cause the walls of the ducts to become fibrotic and stiff. These include primary sclerosing cholangitis (see below), hepatitis and other chronic hepatic diseases leading to cirrhosis. The liver itself becomes rigid and this prevents biliary dilatation. In such cases the lack of dilated bile ducts does not necessarily imply an absence of obstruction
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