A case of choledochocele associated with acute pancreatitis

Abstract

A 63-year-old woman was admitted to our hospital with umbilical pain and vomiting. After a detailed examination, she was diagnosed with acute pancreatitis. Enhanced abdominal computed tomography showed a low-density lesion measuring 13 mm in size at the papilla of Vater and dilatation of the common bile duct. Endoscopic retrograde cholangiopancreatography was performed to rule out the occurrence of choledocholiths. Endoscopic imaging revealed a markedly edematous papilla of Vater protruding into the duodenum. A contrast study revealed a cystic lesion in the wall of the duodenum followed by the bile duct and the pancreatic duct; however, no stone was identified. Her biliary amylase level was markedly elevated at 63350 U/L. Thus, she was diagnosed with choledochocele with the formation of a common duct. Endoscopic sphincterotomy was performed considering that pancreatitis may have been caused by the mixing of bile and pancreatic juice secondary to choledochocele. Her biliary amylase level decreased to within normal limits, and no recurrent pancreatitis has occurred over 15 months.