An Adult Choledochocele Case Presented with Acute Pancreatitis: Treatment by Endoscopic Sphincterotomy and Cyst Unroofing
نویسندگان
چکیده
Choledochocele is a cystic dilatation of the intraduodenal portion of the common bile duct that can protrude into the duodenum. Although often classified as type III biliary cyst, choledochocele has distinctive demographic and anatomic features, and is associated with a lower risk of malignancy as compared to other types of choledochal cysts. Patients with this condition present with biliary colic, cholangitis, or pancreatitis. Until recently, transduodenal cyst excision with or without sphincterotomy had been the treatment of choice. At present, however, endoscopic sphincterotomy and cyst unroofing have become the treatment of choice. We present a case of choledochocele associated with acute pancreatitis that was treated with endoscopic sphincterotomy and cyst unroofing. A 38-year-old woman with a 24-hour history of severe abdominal pain, nausea, and vomiting was admitted to our clinic. On physical examination, mild upper abdominal tenderness was observed. On admission, her amylase level was 3,262 IU/L (reference range, 25 to 125) and her C-reactive protein level was 64 mg/dL (reference range, 0 to 0.8). Transabdominal ultrasonography and magnetic resonance cholangiopancreatography (MRCP) revealed a dilated main pancreatic duct, mild peripancreatic fluid collection, and a cystic lesion 4 cm in diameter that was localized to the second portion of the duodenum. Furthermore, MRCP revealed that the cyst had the same intensity as the biliary tract and that the cyst communicated with the main pancreatic duct and common bile ducts (Fig. 1). Duodenoscopy revealed a soft and pedicular mass covered with normal duodenal mucosa, approximately
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Choledochocele as an atypical cause of relapsing acute pancreatitis: diagnosis and endoscopic treatment.
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عنوان ژورنال:
دوره 48 شماره
صفحات -
تاریخ انتشار 2015