A case of choledochocele with choledocholithiasis presenting as acute pancreatitis

Abstract

A 69-year-old man was admitted to our hospital for further examination of his acute pancreatitis. Abdominal CT and MRCP showed a dilatation of the main pancreatic duct (MPD). ERCP revealed a cystic dilatation of the common channel to a diameter of 7mm. The physiologic stenosis by the sphincter of Oddi intervened between this cystic dilatation and common bile duct (CBD) or MPD, so a diagnosis of choledochocele was made. Although deep CBD cannulation was difficult, precutting using a needle knife made it possible. After endoscopic sphincterotomy (EST), the stone in the CBD was removed with a retrieval balloon Thereafter, a laparoscopic cholecystectomy was performed. In addition, the initial ERCP revealed an elevated amylase level in the bile juice to 13930IU/l, which fell to 604IU/lone month after the EST. Therefore, it was assumed that pancreatic juice had been refluxing into the CBD. This suggested that the presence of a choledochocele with biliopancreatic and pancreatobiliary refluxes was the cause of both the acute pancreatitis and cholelithiasis.