A CASE OF A UNIQUE SHAPE OF COMMON BILE DUCT ACCOMPANIED WITH CHOLEDOCHOLITIASIS

Abstract

A 88-year-old woman who complained of general fatigue and jaundice was admitted to our hospital. Abdominal ultrasonography revealed three stones in the common bile duct (CBD) and dilatation of the intrahepatic bile duct (IHBD). Endoscopic retrograde cholangiography showed many radiolucent shadows in the CBD which was unique in shape. Extraction of stones in the CBD used by electrohydraulic lithotripsy with percutaneous transhepatic cholangioscopy (PTCS) was performed. After three session of extraction, multiple ulcer scars, pseudodiverticulums and severe stenosis were observed in the CBD. Cholangiography revealed longitudinal ulcer scar and diverticulum-like deformity which looks like a sea tangle. Profile of each diverticulum was very smooth. Biopsied specimen of bile duct mucosa revealed no malignant cell except for immf lamation cells. Liver biopsy showed no fibrosis surrounding intrahepatic bile duct. Intraduetal ultrasonography (IDUS) showed a thickend second layer of the CBD wall at the part of scars and stenosis, but thickness of the wall at diverticulum was in normal range. On the results of cholangiography and IDUS, we guess that these stenosis of CBD may be caused by ischemia of choledochal plexus. Therefore, bile duct stones may formed secondarily. Analysis of the cholangiography was important in differential diagnosis between this case and primary sclerosing cholangitis.