PMC3635692_01
a A 2.5-cm-sized heterogeneous SI lesion on the lateral side of the CBD which compressed the duct. b A huge lesion filled the middle level of the CBD and was suspected to be a portion of the cystic duct or gallbladder.
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F1
The location of the impacted stone was suspected to be the cystic duct rather than the CBD, which could cause compression of the CBD (fig. 1a). Injected contrast filled the dilated upstream cystic duct and CBD at the same time and demonstrated that the large stone was laterally compressing the CBD (fig. 1a).
a Laparoscopic view showing an atrophic gallbladder (arrow) and a bulging cystic portion with suspected impacted stones. b Following gallbladder removal, the cystic dilatation was incised to remove the impacted stone. Note the removed black stones and exposed choledochal cyst (arrow).
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F2
However, following removal of the gallbladder and the large impacted stone, surgical exploration revealed a bulging cystic lesion and the surgeon could not find the plastic stent inserted previously in the CBD (fig. 2).
Pathologic examination confirmed the diagnosis of a true choledochal cyst with no malignant change (H&E stain, x100).
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F3
The final diagnosis was confirmed histologically, the specimen showing chronic inflammatory infiltration without dysplasia and denuded epithelium (fig. 3).