A case of high confluence of pancreatobiliary ducts complicated by intraductal papillary neoplasm of the bile duct (IPNB)

Abstract

A 62-year-old woman who had intrahepatic bile duct dilatation on abdominal ultrasonography was admitted to our hospital for further examination. We found dilatation of the common bile duct and elevated amylase levels in the bile on ERCP, and we found high confluence of pancreatobiliary ducts on MRCP. Since, in addition, abdominal contrast-enhanced CT and abdominal contrast-enhanced MRI showed enhancing solid component within a cystic lesion communicating with the left hepatic duct near the porta hepatis, the patient was diagnosed as high confluence of pancreatobiliary ducts complicated by intraductal papillary neoplasm of the bile duct (IPNB) and we underwent central bisegmentectomy of the liver, caudate lobectomy, and extrahepatic bile duct resection. The pathological diagnosis of IPNB with high grade intraepithelial neoplasia was suggested to be IPNB Type 1 based on the site of origin and findings of mucin producing. Since, to our knowledge, no case of high confluence of pancreatobiliary ducts complicated by IPNB has been reported in the literature, we report our case in detail.