2016 Volume 30 Issue 4 Pages 716-722
An 80 years old male admitted with acute cholecystitis and choledocholithiasis. Magnetic resonance cholangiopancreatogram showed a small cystic lesion adjacent to the lower bile duct, common bile duct stones and cystic lesions in the pancreatic head. Endoscopic retrograde cholangiopancreatography demonstrated a 5mm size of diverticulum of the lower bile duct just above the papilla. Intraductal ultrasonography demonstrated the diverticulum connecting to the bile duct, but did not show wall irregularities and a stone in the diverticulum. Endoscopic sphincterotomy and stone extraction were performed. Pancreaticobiliary maljunction was not shown.
From the previous reports, patients with biliary diverticulum had pancreaticobiliary maljunction in 32% and biliary tract cancer in 26%. The patients with lower bile duct diverticulum had a smaller diverticulum. They are thought similar cases of type II congenital biliary dilatation. The patients with middle and upper biliary diverticulum sometimes complicated other congenital biliary abnormalities. To clarify the relationship of the biliary diverticulum and type II congenial biliary dilatation is needed. Further accumulation of cases are required.
