Abstract
An 81-year-old man was admitted to our hospital complaining of abdominal pain. Upon admission, blood analysis showed elevated levels of serum bilirubin and hepatobiliary enzymes, together with an elevated inflammatory reaction. Acute cholangitis due to a common bile duct stone was diagnosed on the basis of imaging results. Endoscopic retrograde cholangiopancreatography was performed to drain the bile duct. Cannulation of the common bile duct was attempted, but insertion of the guide wire proved difficult. An abnormality of the cystic duct junction─where the cystic duct joined the lower bile duct─was suspected on the basis of abdominal computed tomography findings. Cannulation was eventually successful, and an endoscopic nasobiliary drainage (ENBD) tube was placed. The common bile duct stone was removed the following day. Cholangiography through the ENBD tube and magnetic resonance cholangiopancreatography revealed that the cystic duct revolved around the posterior wall of the common bile duct, and that an abnormally low junction existed between the cystic duct and the left-hand side of the common bile duct at the head of the pancreas. The patient elected not to undergo cholecystectomy due to his advanced age, and he was discharged from hospital on day ten. This case demonstrated that it is important to assess the bile duct’s course using imaging studies before initiating treatment.
