Okamoto Hirotaka, Shiba Shugo, Wakana Hiroyuki, Kawashima Kenji, Fukasawa Toshio
Department of Surgery, Tsuru-municipal Hospital, Yamanashi, Japan.
Department of Surgery, Tsuru-municipal Hospital, Yamanashi, Japan.
Int J Surg Case Rep. 2020;76:161-165. doi: 10.1016/j.ijscr.2020.09.137. Epub 2020 Sep 23.
Combination of choledochocele and extra-hepatic duct duplication is an extremely rare congenital abnormality.
The patient was an 81-year-old Japanese man. He visited the emergency room for severe abdominal colic pain. He was diagnosed with severe pancreatitis with cholelithiasis and treated conservatively by percutaneous trans-hepatic gallbladder drainage (PTGBD) for 4 months. Thereafter, he was transferred to our institute and cholangiography was performed via the PTGBD tube, revealing cholecysto- and choledocho-lithiasis. The cystic-duct joined the right hepatic duct with extra-hepatic bile duct duplication and the terminal bile duct flowed into the cystic papilla of Vater. The main pancreatic duct also joined into the cystic papilla. These observations confirmed choledochocele with extra-hepatic bile duct duplication. Surgical exploration was performed, and hepatico-jejunostomy with hepatic-ductplasty and cholecystectomy with choledocholithotomy were carried out. He was discharged and his course was uneventful.
A very rare combined case of choledochocele with bile duct duplication, which would escalate the pancreatitis and cholangitis, was successfully treated. Their pathogeneses in relation to pancreaticobiliary maljunction is discussed.
胆总管囊肿合并肝外胆管重复畸形是一种极其罕见的先天性异常。
患者为一名81岁的日本男性。他因严重的腹部绞痛前往急诊室就诊。他被诊断为重症胰腺炎合并胆结石，并通过经皮经肝胆囊引流术（PTGBD）进行了4个月的保守治疗。此后，他被转至我院，通过PTGBD管进行了胆管造影，显示胆囊和胆总管结石。胆囊管与右肝管相连，存在肝外胆管重复畸形，终末胆管流入十二指肠乳头的胆囊小乳头。主胰管也汇入十二指肠乳头。这些观察结果证实为胆总管囊肿合并肝外胆管重复畸形。进行了手术探查，实施了肝管成形术的肝空肠吻合术以及胆总管切开取石术的胆囊切除术。他出院了，恢复过程顺利。
成功治疗了一例非常罕见的胆总管囊肿合并胆管重复畸形的病例，这种情况会加重胰腺炎和胆管炎。讨论了它们与胰胆管连接异常相关的发病机制。
