PMC4560140_01
Preoperative diagnosis on MDCT and MRCP. Preoperative MDCT revealed mild dilation of the common bile duct (a) and a coalesced gallbladder with the bile duct (arrow), suggesting biliobiliary fistula (small arrow head) (b). Preoperative MRCP showed a solitary gallstone in the gallbladder (c, large arrow head), dilation of the intrahepatic bile duct, and biliobiliary fistula (d)
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Fig1
MDCT revealed mild dilation of the common bile duct and a coalesced gallbladder with the bile duct (Fig. 1) suggesting MS with BBF. MRCP also detected a solitary gallstone at the most distal site of the dilated bile duct (Fig. 1).
Preoperative cholangiography through an ENBD tube. Preoperative cholangiography through the ENBD tube may show bile duct compression by the gallstone. Inflow of the contrast media into the atrophied gallbladder (arrow, a) and compressed bile duct (arrow head, b)
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Fig2
The patient underwent ERCP including endoscopic sphincteropapillotomy (EST), followed by ENBD (Fig. 2), and the severe inflammation status and obstructive jaundice were immediately improved.
Schema of the intraoperative findings. This schema showed intraoperative findings of the case. The dashed line is solid gallstone in the neck of the gallbladder (a). Schema of the operative procedure (b, c)
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Fig3
The patient showed a good postoperative course, and profluent flow in the bile duct was confirmed by postoperative direct cholangiography and MRCP (Fig. 3).
Postoperative cholangiography through an ENBD tube and postoperative MRCP. Postoperative cholangiography through the ENBD (1 week after surgery, a) and MRCP (1 month after surgery, b) showed profluent flow in the bile duct, no stagnant fluid in the remnant gallbladder, and no dilation of the upper bile duct (arrow heads surgical repair site, arrow cystic duct)
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Fig4
We herein described a rare case of MS with BBF type I with a markedly atrophied gallbladder that was successfully managed by endoscopic diagnostic therapy followed by a minimally invasive surgical procedure (Fig. 4).