PMC5849811_01
Contrast-enhanced computed tomography (CT):(a) Dilation of intrahepatic bile duct and heterogeneous early stain in post-partial hepatectomy liver parenchyma on arterial phase. (b) Dilation of common and bile duct and main pancreatic duct, juxtapapillary duodenal diverticulum. No appatent bile duct stones were found.
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No apparent bile duct stones were found (Fig. 1).
ERCP: (a) Major duodenal papilla could not be visually recognized because of large juxtapapillary duodenal diverticulum and food residue hard to remove. (b) Mucosa of proximal side of major duodenal papilla was cut and common bile duct was exposed. (c) In the cholangiography, no stone and debris was found. Endoscopic biliary drainage tube via the exposed common bile duct was indwelled.
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The proximal side of major duodenal papilla was cut and cannulated to the exposed common bile duct (Fig. 2a,b). It was felt that the cholangitis occurred due to biliary obstruction from a juxtapapillary duodenal diverticulum, so-called Lemmel syndrome and an indwelling endoscopically biliary drainage tube was placed (Fig. 2c) and cefazolin was administered as antimicrobial therapy.