Laparoscopic cholecystectomy should be performed due to the high frequency of concomitant gallbladder carcinoma. Surgery to separate the pancreatic juice and bile by bile duct resection and hepaticojejunostomy is controversial. The development of carcinoma in the bile duct in cases of pancreaticobiliary maljunction without dilatation of the bile duct is rare, and the high incidence of cholangitis after hepaticojejunostomy makes most doctors think that surgery for the separation of pancreatic juice and bile is not necessary .
Operative findings of congenital dilatation of the common bile duct of a cystic form
Congenital dilatation of the bile duct is described above. We now address pancreaticobiliary maljunction without bile duct dilatation.
With regard to the hepatic side of the bile duct, the dilated part should be removed as much as possible. However, in cases with bilateral dilatation of both the right and left hepatic bile duct, complete resection of the dilated part of the bile duct is impossible. Furthermore, aggressive surgery should not be performed for benign lesions. Therefore, if there is no stenosis between intrahepatic bile ducts and either the right or left side of the hepatic duct, some dilated parts can be left and cut to prevent excess damage to the liver.
Carcinoma of the bile duct is reported to occur in 30% to 40% of cases of pancreaticobiliary maljunction without dilatation of the bile duct. Gallbladder carcinoma develops in more than 90% of such instances.
Examinations of the blood count and chemistry
In these cases, abdominal pain, jaundice, and abdominal mass are thought to be a triad. Abdominal pain is found in about 80% of cases, jaundice in 30–50%, and abdominal mass in about 10%. High fever, nausea, and vomiting accompanied by cholangitis or pancreatitis are also frequent. The important examinations for diagnosis are shown below.
In cases with a past history of cystduodenostomy or cystjejunostomy
Congenital dilatation of the common bile duct is a disease in which the extrahepatic bile duct, or both the extra and intrahepatic bile ducts, is dilated in various ways, from a spindle form (Fig. 1) to a cystic form  (Figs. 2 and 3). Typically, the common bile duct dilates cystically, which is why this is also called choledochal cysts.
Congenital dilatation of the common bile duct has been shown to be very closely related to pancreaticobiliary maljunction. On the other hand, the bile duct is not dilated in some cases of pancreaticobiliary maljunction.
Results: The search yielded a total of 882 articles, and after careful individual review for eligibility and relevancy, 9 peer-reviewed studies were included. A cause of the CBD dilation was found on average in 33% of cases and the most common causes were: CBD stone, chronic pancreatitis, and periampullary diverticulum. The overall CBD diameter was not associated with finding a causative lesion. Coexisting CBD and intrahepatic bile duct dilation, age, and jaundice were found to be indicators of pathologic lesions. Dilation of both the CBD and pancreatic duct was suggestive of pancreatic disease, especially pancreatic malignancy in the setting of obstructive jaundice. Follow-up was reported in 6 studies ranging from 6 to 85 months, and generally there was no change in the diagnosis.
Goals: A systematic review of studies on patients with dilated CBD was performed to identify etiologies and clinical factors that may predict which patients require further diagnostic testing and long-term outcomes. A PubMed search for relevant articles published between 2001 and 2014 was performed.
Background: With the widespread use of abdominal imaging, an incidentally found dilated common bile duct (CBD) is a common radiographic finding. The significance of a dilated CBD as a predictor of underlying disease and long-term outcome have not been well elucidated.
Conclusions: Incidentally found biliary tract dilatation can be a manifestation of significant biliary tract disease including malignancy. Long-term outcome is not well defined and further prospective studies examining the most cost-effective approach to evaluation are needed.