A Case of Pancreatico-biliary Maljunction and Asymptomatic Stones in the Cystic Dilatated Common Bile Duct

Abstract

A 66-year-old female was admitted to our hospital because of the rupture of esophageal varices due to chronic type C hepatitis. Bleeding was controlled by endoscopic variceal ligation. This patient was found to have pancreatico-biliary meljunction (PBM) and cystic dilatation of the common bile duct (CBD) with asymptomatic stones by ultrasound sonography (US) , endoscopic retrograde cholangio-pancreatography (ERCP) , and magnetic resonance cholangio-pancreatography (MRCP) .
Abdominal US revealed a slight dilatation of bilateral hepatic bile ducts and marked dilatation of CBD with stones. ERCP revealed cystic dilatation of CBD with several stones (about 2×2cm) , bilateral hepatic bile duct and PBM. Common channel was about 45mm and narrow segment was about 5mm. According to New Komi's classification, she was diagnosed as type Ib. The PBM has been recognized as one of the significant etiological factors developing dilatation of CBD as well as carcinomas in the biliary tract. Cancer usually occurs in younger generation than general population. However, in this case no cancer was found in the resected gallbladder and dilated extrahepatic bile duct.