Korean Journal of Gastrointestinal Endoscopy 1998;18(5): 781-787.
증례 : 담도 췌장 ; 유두부 괄약근 절개술로 치유한 Choledochocele ( Case Reports : Biliary Tract & Pancreas ; Treatment Using an Endoscopic Sphincterotomy for Two Patients with Choledochocele )
송승찬, 문광호, 조균석, 최호순, 이오영, 한동수, 손주현, 전용철, 윤병철, 함준수, 이민호, 기춘석, 박경남, 임현철 (Seung Chan Song, Kwoang Ho Mun, Kyoon Seok Cho, Ho Soon Choi, Oh Young Lee, Dong Soo Han, Joo Hyun Sohn, Yong Chul Jun, Byung Chul Yoon, Joon Soo Hahm, Min Ho Lee, Choon Suhk Kee, Kyung Nam Park and Hyun Chul Lim)
Abstract
A choledochocele is a cyst like herniation of the intramural segment of the distal common bile duct protruding into the duodenal lumen. It is controversial whether this disease entity represents a type III variation of a choledochal cyst or an acquired lesion due to a calculus, papillitis or sphincter of Oddi dysfunction. The choledochocele is the rarest form of choledochal cysts and represents only 1.4-5.0% of all choledochal cysts. The diagnosis of choledochocele can be confirmed with certainly using a cholangiography. During a side viewing duodenoscopy followed by retrograde cholangiopancreatography, the mucosa appears normal but the papilla may be larger than usual. When probing the choledochocele with a cannulating catheter, its surface may be appear to be soft and compressible, similar to the pillow sign. After contrast dye is instilled into the bile duct, a round, cyst-like contrast filled structure can be identified adjacent to the terminatian of the common bile duct and an air halo sign may be visible around it. The established treatment of choledochocele is surgical resection of the cyst with anastomosis of the common bile duct to the small intestine, but transduodenal sphincteroplasty or endoscopic sphincterotomy has been advocated as an alternative to excision because of the very low risk of malignant degeneration, operative complications and morbidity. The choice of therapy for the patients with symptomatic choledochchocele is to establish effective drainage of the common bile duct and pancreatic duct. The objective can be achieved using an endoscopic sphincterotomy or transduodenal sphinateroplasy. It has been determined in recent years that endoscopic sphincterotomy is v effective and often followed by a positive prognosis. We report two patients with reicurrent pancreatitis and the common bile duct dilatation secondary to a choledochoce]e, who were treated effectively by endoscopic sphincterotomy. (Korean J Gastrointest Endosc 18: 781-787, 1998)
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