Abstract
A 59-year-old man, who had been complaining of epigastric discomfort since 1985 and was pointed out the abnormal findings of the gall bladder by ultrasonography (US), was admitted to our hospital for further examination of the gall bladder on June 22 1987. No abnormal findings were detected on the initial laboratory investigations. US and CT showed an oval-shaped mass with a clear margin in the gall bladder. The main pancreatic duct and the cystic duct was detected at the same time on ERCP and an oval radiolucent mass with a clear margin was detected in the gall bladder. But the relationship between the common bile duct and the cystic duct was ulclear. Percutaneous transhepatic cholecys-tography revealed a movable well-defined oval-shaped mass in the gall bladder. Contrast medium flowed into the duodenum, but the common bile duct was not detected. The bile aspirated from gall bladder was a water-like non-colored liquid. This case was diagnosed cholecystolithiasis and cholecytectomy was performed. Intra-operative cholecystography showed the direct connection of the cystic duct to the main pancreatic duct and no detection of the common bile duct. There was a milky-white soft mass with a size of 60×40×25mm in the gall bladder. That was consisted of protein more than 99%. On the histological examination, mild inflammation without cancerous invasion was found. Postoperative ERCP showed that cystic duct connected the main pancreatic duct directly at the nearer part to the great duodenal papilla than at the bifurcation of Santorinii duct and there was no communication between the cystic duct and the common bile duct.
