Abstract
The patient was a 61-year-old man who had a chief complaint of abdominal pain and high fever. According to CT and US examination, he was diagnosed as choledocholithiasis. Endoscopic findings demonstrated two separated orifices. The orifice on the oral side was located inside the diverticulum. Endoscopic retrograde cholangiography (ERC) revealed three stones,13 to 15 mm in diameter, in the common bile duct (CBD) Endoscopic papillary balloon dilation (EPBD) was performed and CBD stones were removed after broken by mechanical lithotripsy (ML). Two days later, laparoscopic cholecystectomy (Lap-C) was performed for cholecystolithiasis. On the sixth postoperative day, two residual stones in CBD were completely removed endoscopically. No complications after the removal of stones by EPBD occurred. The separated orifice of the common bile duct from the pancreatic duct orifice was rarely encountered, and was reported to appear at lower than 4% in Japan. EPBD seemed useful and safe for the treatment of CBD stones even with the bile duct opening inside the diverticulum.
