담관낭종 불완전 절제 후 잔류 낭종에 발생한 거대 췌석

Large Pancreatolith Formed in the Remnant Cyst after Incomplete Excision of Choledochal Cyst

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Korean J Pancreas Biliary Tract. 2018;23(2):87-88

Publication date (electronic) : 2018 April 30

doi : https://doi.org/10.15279/kpba.2018.23.2.87

Ah Lim Kim, Sung Bum Kim, Kook Hyun Kim, Tae Nyeun Kim

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea

김아림, 김승범, 김국현, 김태년

영남대학교 의과대학 내과학교실

Corresponding author : Tae Nyeun Kim Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel. +82-53-620-3316 Fax. +82-53-623-8001 E-mail; tnkim@yu.ac.kr

Received 2017 December 10; Revised 2018 January 23; Accepted 2018 January 23.

A 44-year-old female was admitted due to recurrent epigastric pain. She had undergone excision for a congenital choledochal cyst at the age of 27 years. Laboratory findings were as follows: white blood cell count of 4,600/mm³, total bilirubin of 0.7 mg/dL, aspartate transaminase of 38 IU/L, alanine transaminase of 20 IU/L, gamma-glutamyl transpeptidase of 30 IU/L, and serum amylase of 242 IU/L. Both abdominal computed tomography and magnetic resonance cholangiopancreatography showed findings compatible with remnant choledochal cyst with 15 mm sized pancreatic stone in the head portion (Fig. 1, 2). Endoscopic retrograde cholangiopancreatography revealed presence of anomalous pancreatobiliary junction, remnant choledochal cyst, and a filling defect in the pancreatic duct (Fig. 3). A white, fragile stone was removed after endoscopic sphincterotomy (Fig. 4). The patient remained asymptomatic without any complications after discharge. Although management of remnant choledochal cyst without symptoms is less clear [1,2], endoscopic sphincterotomy may be useful for the treatment and prevention of pancreatolith in patients with remnant choledochal cyst. Furthermore, complete excision of congenital choledochal cyst is necessary [3]. Incomplete resection of the cyst may cause pancreatic duct stone or protein plug formation in the remnant choledochal cyst [4,5].

Fig. 1.

Abdominal computed tomography showed remnant choledochal cyst with a 15 mm sized hyperdense lesion in the pancreatic head portion (arrow).

Fig. 2.

Magnetic resonance cholangiopancreatography showed remnant choledochal cyst with a signal void lesion in the pancreatic head portion (arrow).

Fig. 3.

Pancreatic duct stone extraction was done by using a basket under fluoroscopic guidance.

Fig. 4.

Endoscopic view of the removed pancreatic duct stone. A white, fragile stone was removed after endoscopic sphincterotomy.

References

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2. Koshinaga T, Hoshino M, Inoue M, et al. Pancreatitis complicated with dilated choledochal remnant after congenital choledochal cyst excision. Pediatr Surg Int 2005;21:936–938.

3. Ishibashi T, Kasahara K, Yasuda Y, Nagai H, Makino S, Kanazawa K. Malignant change in the biliary tract after excision of choledochal cyst. Br J Surg 1997;84:1687–1691.

4. Nakano K, Mizuta A, Oohashi S, et al. Protein stone formation in an intrapancreatic remnant cyst after resection of a choledochal cyst. Pancreas 2003;26:405–407.

5. Chiba K, Kamisawa T, Egawa N. Relapsing acute pancreatitis caused by protein plugs in a remnant choledochal cyst. J Hepatobiliary Pancreat Sci 2010;17:729–730.

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