Abstract
A 77-year-old man who visited neighboring hospital because of epigastric pain lasting from August 2010 was referred to our hospital with a suspected diagnosis of acute cholangitis in the same August. Blood analysis revealed no increases in hepatic function indicators and biliary enzyme levels, but showed inflammatory findings. Magnetic resonance cholangiopancreatography (MRCP) and abdominal contrast-enhanced CT scan showed slight dilatation of the intrahepatic bile duct and stricture of the common bile duct, but demonstrable tumor shadow was absent. Endoscopic retrograde cholangiopancreatography (ERCP) failed to visualize the gallbladder, suggesting the stricture of the common bile duct to be due to extramural compression. Three-dimensional integrating images using MD-CT and DIC-CT confirmed that the cystic artery compressed the common bile duct dorsad. Since a possibility of malignancy could not be ruled out completely for cholecystitis, cholecystectomy under laparotomy was performed in September 2010. Intraoperative findings were compatible with 3D integrating images. The histopathological diagnosis was chronic cholecystitis.
It is very rare that the cystic artery causes extrahepatic bile duct stricture like in this case, and no cases have been reported in which preoperative 3D-CT successfully diagnoses the disease. This case is thus reported here, with a review of the literature.
