A case of congenital biliary dilatation with pancreatic stone treatment by ESWL prior to the shunt surgery

Abstract

A 30-year-old woman at 30 weeks gestation presented with vomiting and abdominal pain. She was given a diagnosis of congenital biliary dilatation at a local hospital and was referred to our hospital after giving birth. Cholangiopancreatography showed cystic dilatation from the left hepatic bile duct to the inferior bile duct, stenosis of the left hepatic bile duct, with dilatation and a defect of the Wirsung duct, yielding a diagnosis of congenital biliary dilatation of Totani Type IV-A with an incarcerated pancreatic stone. Endoscopic treatment was seemed to be difficult because of the imaging findings. After crushing the pancreatic stone by extracorporeal shock wave lithotripsy (ESWL), the patient underwent resection and reconstruction of the extrahepatic bile duct. We report a rare case of an incarcerated pancreatic stone accompanying congenital biliary dilatation that was treated successfully by ESWL and resection and extrahepatic bile duct reconstruction.