PMC7184792_01
Endoscopic ultrasound depicting common bile duct dilatation and the presence of a choledochal cyst.
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F1
An EUS was performed and revealed a dilated extrahepatic biliary duct of 20 mm extending from the common hepatic duct down to the distal common bile duct (CBD) indicating a type 1A CC with choledocholithiasis, but no aberrant pancreaticobiliary junction (Fig. 1).
Endoscopic retrograde cholangiopancreatography displaying the minor pancreatic duct (red), connection between minor duct and choledochal cyst (green), choledochal cyst (yellow), and pancreatic duct distal to the choledochal duct (blue), illustrating that as bile continued to flow from the choledochal cyst, the contrast opacification from the cyst decreased and subsequent loss of opacification between the connection from the pancreatic duct and the choledochal cyst occurred as well.
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F2
An ERCP was performed (Fig. 2) and the CBD was unable to be cannulated via the major papilla, even with a 39Rx sphincterotome with 0.025 guidewire.
Endoscopic image of bile flowing from minor papilla.
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F3
Interestingly, there was a large amount of bile flowing from the minor papilla (Fig. 3).
Intraoperative cholangiogram showing cystic dilatation of the common bile duct indicating a type IA choledochal cyst. Reproduced with permission.
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F4
A subsequent cholangiogram/pancreatogram demonstrated a connection from the duct of Santorini (minor duct) to CC (Fig. 4).