PMC5741138_01
Secretin-enhanced magnetic resonance cholangiopancreatography showed a T2 hyperintense cystic lesion at the major papilla communicating with the common bile duct and the pancreatic duct. No anomalous pancreatico-biliary junction was noted.
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F1
Secretin-enhanced magnetic resonance cholangiopancreatography showed a 16 mm x 11 mm T2 hyperintense cystic lesion at the major papilla (Figure 1).
Endoscopic ultrasound showed an intramural (subepithelial), heterogeneous, mixed (cystic and solid), hypoechoic (with anechoic center) lesion at the major papilla. This appeared to be in communication with the common bile duct and the pancreatic duct.
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F2
Upper endoscopic ultrasound (EUS) showed a 15 mm x 10 mm oval, intramural, subepithelial lesion at the major papilla (Figure 2).
Endoscopy showed a large bulging lesion with normal overlying mucosa at the major papilla.
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F3
Endoscopic retrograde cholangiopancreatography (ERCP) showed an 18-mm bulging lesion at the major papilla with normal overlying mucosa (Figure 3); injected contrast collected into a 16-mm cystic cavity (Figure 4).
Endoscopic retrograde cholangiopancreatography showed cystic dilatation of the intraduodenal portion of the common bile duct and the pancreatic duct. No anomalous pancreatico-biliary junction was noted.
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F4
Endoscopic retrograde cholangiopancreatography (ERCP) showed an 18-mm bulging lesion at the major papilla with normal overlying mucosa (Figure 3); injected contrast collected into a 16-mm cystic cavity (Figure 4).
Endoscopy showed adequate unroofing of the previously diagnosed type A choledochocele.
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F5
Follow-up ERCP at 4 weeks showed adequate unroofing of the choledochocele (Figure 5); the pancreatic stent was subsequently removed.