2023 Volume 56 Issue 5 Pages 256-262
The patient was a 21-year-old female who had undergone extrahepatic bile duct resection via Roux-en Y choledochojejunostomy for congenital biliary dilatation at age 10. Eleven years after the surgery, she visited our hospital with a chief complaint of epigastric pain. Blood tests revealed an elevated inflammatory response, and CT showed a 50-mm cystic lesion in the pancreatic head, leading to a diagnosis of residual intrapancreatic cholangitis. Based on the previous surgical findings, we considered that inadequate resection of the dilated bile duct was the cause, and performed a residual dilated bile duct resection. In the operation, a thinned pancreatic parenchyma in front of the residual dilated bile duct was dissected to identify the residual bile duct. The intrapancreatic residual bile duct was removed just above the confluence of the pancreatic ducts. The standard treatment for congenital biliary dilatation is resection of the extrahepatic bile duct and biliary tract reconstruction. This case shows that inadequate resection of a dilated bile duct may result in postoperative bile duct inflammation and carcinogenesis.
