PMC7548400_01
A. Cholangiography from the PTGBD tube. Asterisk indicates choledocholithiasis. The large white arrow indicates the bifurcation between the right and left bile ducts. The small arrow indicates the junction of the cystic duct of the gallbladder to the right bile duct. The arrowhead indicates the left bile duct.. B. Endoscopic view of the papilla of Vater during ERCP. The papilla of Vater was swollen with a single orifice, from which biliary fluid was observed.. C. Magnified view of the duodenal papilla on cholangiography. Contrast medium was pooling in the terminal bile duct at the junction of the main pancreatic duct, indicating choledochocele.
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Cholangiography was performed from the PTGBD tube, revealing the filling defect of stone (asterisk in Fig. 1A), the junction of the cystic duct to the right hepatic duct (thin white arrow in Fig. 1A), and the lower junction of the right and left hepatic ducts (thick white arrow in Fig. 1A). Furthermore, the terminal bile duct flowed into the cystic papilla of Vater and the main pancreatic duct joined into the cystic papilla (Fig. 1C). Duodenal endoscopy also revealed swelling of the papilla of Vater with a normal orifice (Fig. 1B).
Abdominal CT view. The white arrow indicates a small intraduodenal cystic lesion adjacent to the pancreas head (A, Tranverse view, B, Coronal view), indicating choledochocele.
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On abdominal CT, a cystic lesion with similar wall characteristics to those of the duodenal wall at the papilla of Vater of the descending portion of duodenum was noted (white arrow in Fig. 2A, B), suggesting choledochocele.
A. Intraoperative findings. The right extra-hepatic bile duct was isolated by taping. Bifurcation was noted just above the duodenal bulbus (B, schematic view).
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Intraoperative findings included duplication of the extrahepatic bile ducts (Fig. 3).