Abstract
A 53-year-old man admitted to our hospital with a complaint of epigastralgia. Ultrasonography showed some small stones in the gallbladder. Magnetic resonance cholangiopancreatography (MRCP) revealed two stones, about 5mm in diameter, in the common bile duct (CBD) . Endoscopic examination showed two separated papillae which had each orifice, and the oral papilla was located inside the diverticulum. Endoscopic retrograde cholangiopancreatography (ERCP) revealed two stones, 5mm in diameter, in CBD and couldn't prove the existence of choledocoduodenal fistura. From these findings, we diagnosed as CBD stones with the completely separation of CBD and the main pancreatic duct (MPD) . Endoscopic papillary balloon dilatation (EPBD) was performed and CBD stones were completely removed by a balloon catheter endoscopically. After that, laparoscopic cholecystectomy was performed for cholecystolithiasis.
The completely separated orifices of CBD and MPD is rare, reported to be lower than 4% in Japan. EPBD is thought to be safe and useful for the treatment of CBD stones in the patient with the complete separation of CBD and MPD, especially the orifice of CBD was located inside the diverticulum.
