Choledochocoele

Case contributed by Dr Eric F Greif

Presentation

Abdominal pain and jaundice.

Patient Data

Age: 65 years
Gender: Male
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. These findings are consistent with a choledochocele (choledochal cyst type III under the Todani classification system). Gallstones are also 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 of common duct stones. No pericholecystic inflammatory signal noted. no pancreatic ductal dilatation.

Fluoroscopy

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

The second image shows the position after stent placement.

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. Choledocholithiasis 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 patient's pain and jaundice. 

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Case information

rID: 29505
Published: 31st May 2014
Last edited: 28th May 2019
Inclusion in quiz mode: Included

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