Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
Corresponding author:
Myung Hwan Kim,
ABSTRACT
Background/Aims: Choledochocele is a rare abnormality involving the intramural segment of the common bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) is essential to demonstrate a choledochocele. The aim of this study was to investigate the duodenoscopic and cholangiographic findings during ERCP examination. Methods: Over a five year period, seventeen symptomatic patients (8 male, 9 female, age range 45-83 years) were identified as having choledochoceles. The diagnosis of choledochocele was made by both duodenoscopic and cholangiographic findings. Results: As a characteristic duodenoscopic finding, the enlarged bulging papilla was noted in 8 (47%) patients, whereas normal-appearing papilla was noted in 9 (53%) patients before the injection of contrast medium. However, in all 17 patients progressive enlargement or ballooning of the papilla was noted during contrast injection. As a characteristic cholangiographic finding, a round cyst-like, contrastfilled structure was identified in all patients adjacent to the termination of common bile duct. The longest diameter of the choledochocele, determined by cholangiography, was significantly larger (19±4 mm) in patients with initially bulging papilla than in those with normal-appearing papilla (9±3 mm)(p<0.05). Conclusion: These results suggest that ballooning papilla during contrast injection may be a pathognomonic duodenoscopic finding for the diagnosis of a choledochocele. To avoid missing a choledochocele, to watch the papilla carefully during contrast injection may be very important.
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