2019 Volume 33 Issue 2 Pages 244-249
A woman in her sixties was referred to our hospital with suspected CBD. Enhanced CT and MRCP showed a fusiform CBD of 18mm in diameter. We made a diagnosis of Todani Ic CBD. As she denied consent to ERCP, we were unable to detect the pancreaticobiliary maljunction (PBM) preoperatively. We performed intraoperative cholangiography repeatedly and identified the PBM. We then resected the extra-hepatic CBD from the circumference of the hepatic ducts to the proximal superior of the pancreatic bile junction safely. Recent advancements in image modalities have enabled us to diagnose PBM without cholangiography, but in our case, intraoperative cholangiography was the only way to diagnose PBM because the papillary sphincter extended immediately inferior to the circumference of the PBM. Furthermore, repeated intraoperative cholangiography was useful to resect the biliary tract safely.
