Abstract
A 44-year-old man was referred to our hospital complaining of right hypochondralgia in June 2007. He had been diagnosed as to have cholelithiasis at a neighboring hospital since 2003, but he was asymptomatic. Laboratory data showed mild endocrine and exocrine dysfunction of the pancreas, though hepatic and biliary enzymes and tumor markers were in normal ranges. Imaging examinations (CT, MRI, ERCP and angiography) showed gallbladder, common bile duct and pancreatic stones, accompanied by pancreaticobiliary maljunction, and visualized a tumor image with stricture at the inferior bile duct. MRI showed the fatty replacement of the pancreatic body and tail. Angiography visualized the dorsal pancreatic artery. Laparotomy was performed with a suspicion of an intraductal tumor at the distal common bile duct (CBD). Intraoperative cholangioscopy and histological examination showed no malignancy. The CBD stones and pancreatic stones were removed without performing pancreatic resection. Choledochojejunostomy and pancreatic duct drainage were performed following CBD resection. Endocrine and exocrine functions of the pancreas were restored after the operation. The patient has been free from abdominal symptoms as of 8 years after the operation.
