抄録
Case: 70 years old female. She had been cholecystectomized because of the gallbladder stone 12 years ago. Since 6 years before the admission in our clinic, she had been suffered from upper abdominal discomforts and right hypochondralgia. On admission, there was no abnomality in the laboratory findings. Plane film of the abdomen revealed the pneumobilia. Upper GI series showed reflux of barium meal from the internal midportion of the duodenum to the common bile duct. Drip infusion cholangiography was negative. Endoscopic observation of the duodenum and ERCP were performed. There found parapapillary choledochoduodenal fistula about 1cm oral from the crif ice of the major papilla. The cannula was inserted through both fistula and the orifice of the major papilla to the common bile duct, and the visualization of the biliary tract by 50% Urografine revealed no stone. It was considered that her symptome was caused by reflux cholangitis. In order to make fistula larger and to make reflux contents in the common bile duct flow rapidly and easily into the duodenum, endoscopic electrosurgical sphincterotomy was tried. From the orifice of the papilla to the fistula, special designed cutting knife was inserted and a current for cutting was applied using Olympus PSD. Endoscopic sphincterotomy was performed safely and successfully. By this method, narrow distal segment extending from the orifice of the papilla to the fistula was cut down and the orifice of the fistula was opened widely. After this procedure, reflux contents flowed out easily into the duodenum, and her symptome disappeared completely. It was considered that the endoscopic electrosurgical sphincterotomy was useful to cure reflux cholangitis caused by the parapapillar choledochoduodenal fistula.
