Choledochocoele

Case contributed by Dr Eric F Greif

Presentation

Abdominal pain and jaundice

Patient Data

Age: 65
Gender: Male
Modality: MRI

Distal portion of the common bile duct is mildly dilated measuring 0.8 to 0.9 cm in caliber. There is bulging of the ampulla into the duodenum with a rounded appearance noted distally in the duct. Finding are consistent with choledochocele (choledochal cyst  type III under the Todani classification system). Gallstones are noted. On some of the sequences (not all included) there are multiple low signal intensity filling defects within the common duct including the distal duct. These are suspicious for common duct stones. No pericholecystic inflammatory signal noted. no pancreatic ductal dilatation.

Modality: Fluoroscopy

Focal area of contrast accumulation in the region of the distal duct consistent with choledochocele seen on recent MRCP.

Case Discussion

The gentleman complained of progressive abdominal pain and presented with jaundice.  As described above findings were consistent with choledochocele (choledochal cyst  type III under the Todani classification system). On some of the sequences there were multiple low signal intensity filling defects within the common duct including the distal duct. These were suspicious for common duct stones, even though they are not visualized on all pulse sequences. Gallstones were also noted. Choledocolithiasis is likely the cause of patients pain and jaundice. 

ERCP was subsequently performed. The common bile duct stones were removed and a biliary stent was placed. This relieved the patients pain and jaundice. 

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Case Information

rID: 29505
Case created: 30th May 2014
Last edited: 22nd Nov 2016
Inclusion in quiz mode: Included

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