PMC4897015_01
31-year-old man with recurrent pancreatitis and choledochocele. Initial abdominal radiograph shows enlarged gallbladder (arrow).
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In retrospect, however, the outline of an enlarged gallbladder is visible in the right upper quadrant on the radiograph (Fig. 1).
31-year-old man with recurrent pancreatitis and choledochocele. Initial abdominal sonogram demonstrates (A) an enlarged gallbladder with thickened wall and increased pericholecystic fluid (arrow), and (B) dilated common bile duct (cross-hatches).
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The ultrasound is remarkable for an enlarged gallbladder with thickened wall and pericholecystic fluid (Fig. 2A), as well as dilation of the common bile duct (Fig. 2B).
31-year-old man with recurrent pancreatitis and choledochocele. Axial CT demonstrates 7 mm cystic structure within duodenal lumen (white arrow) and pancreatic duct (black arrow) communicating with cyst. Axial CT movie.
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Further investigation of the etiology of the pancreatitis included CT of the abdomen and pelvis, which demonstrated a 7 mm intraduodenal cystic structure extending from the pancreatic duct into the second portion of the duodenum (Figure 3, Figure 4), most consistent with a type III choledochal cyst.
31-year-old man with recurrent pancreatitis and choledochocele. Reformatted oblique sagittal CT shows common bile duct (black arrow) and pancreatic duct (arrow head) in direct communication with cyst (white arrow). Sagittal CT movie.
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Further investigation of the etiology of the pancreatitis included CT of the abdomen and pelvis, which demonstrated a 7 mm intraduodenal cystic structure extending from the pancreatic duct into the second portion of the duodenum (Figure 3, Figure 4), most consistent with a type III choledochal cyst.
31-year-old man with recurrent pancreatitis and choledochocele. Reformatted oblique MRCP shows (A) intraluminal duodenal cyst and (B) pancreatic duct (arrows).
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T2-weighted sequences with thin and thick slab MIP images of the biliary tree (Fig. 5).
31-year-old man with recurrent pancreatitis and choledochocele. ERCP demonstrates intraluminal choledochal cyst (white arrow) direct communication with dilated common bile duct (black arrow) and pancreatic duct (arrowhead).
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Once the ducts were visualized, cystic dilatation at the beginning of the pancreatic and bile ducts was observed, consistent with a type III choledochal cyst (Fig. 6).
31-year-old man with recurrent pancreatitis and choledochocele. Intraoperative photos show cyst within the duodenum (A) and, after cyst resection, the orifices of the common bile and pancreatic ducts (B).
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Once the cyst was visualized, it was apparent that the cyst itself had a very small ampullary orifice, such that a probe could not be passed through it (Fig. 7A). The cyst wall was opened, and there were 2 visible openings, one for the pancreatic duct and one for the common bile duct, draining directly into the cyst (Fig. 7B).