Abstract
A 52-year-old man was admitted to our hospital because of upper abdominal pain, and found to have dilatation of the common bile duct by US. Abdominal CT demonstrated significant dilatation of the extrahepatic bile duct and proptosis of the cystic lesion to the duodenal lumen. EUS revealed 15 millimeter common bile duct, and the terminal expanded to duodenal lumen after becoming thin. ERCP showed dilatation of the common bile duct and successive cystic lesion to the terminal. Also, after contrast enhancing, neighborhood of major papilla seemed to be a submucosal tumor and protruded into duodenum. After confirming debris in the common bile duct by IDUS, we performed EST. ERP and MRCP demonstrated absent pancreaticobiliary maljunction. From above-mentioned results, we made diagnoses of choledococele and type IV-B congenital biliary dilatation. The next day of ERCP, pancreatitis occurred because of hematoma in the choledococele caused by bleeding after EST, and we performed emergency ENBD and argon plasma coagulation therapy for the ulcer after EST. We reported a case of type IV-B congenital biliary dilatation which was a significantly rare disease with choledococele causing bleeding after EST.
