Department of Gastroenterology, Graduate School of Biomedical & Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
Clin J Gastroenterol. 2024 Feb;17(1):177-182. doi: 10.1007/s12328-023-01873-z. Epub 2023 Oct 18.
Congenital biliary dilatation (CBD) is a congenital malformation of focal dilatation of the extrahepatic bile ducts, including the common bile duct, and is often associated with pancreaticobiliary maljunction (PBM). In this article, we report a CBD case that presented with focal dilation of the common bile duct without PBM (Todani's classification type Ib). The patient was a 32-year-old man who visited a doctor with a chief complaint of abdominal distension. Computed tomography revealed cystic dilatation of the common bile duct, and the patient was referred to our institution. Magnetic resonance cholangiopancreatography showed cystic dilatation of the common bile duct with a maximum diameter of 7 cm; however, evaluating the presence of PBM was challenging. Endoscopic ultrasonography showed small gallstones and debris in the dilated common bile duct and no thickening of the gallbladder wall. Endoscopic retrograde cholangiopancreatography revealed no PBM or markedly elevated bile amylase levels. Based on these findings, the patient was diagnosed with Todani Type Ib CBD. Since this patient did not have pancreatobiliary reflux, it was unclear whether the risk of developing biliary tract cancer was high, and since the treatment was highly invasive, the decision was to follow up without surgical treatment.
先天性胆管扩张症(CBD)是一种肝外胆管局限性扩张的先天性畸形,包括胆总管,并常伴有胰胆管合流异常(PBM)。本文报道了一例 CBD 病例,其表现为胆总管局限性扩张而无 PBM(Todani 分类 Ib 型)。患者为 32 岁男性,因腹胀就诊。计算机断层扫描显示胆总管囊性扩张,患者被转至我院。磁共振胰胆管成像显示胆总管囊性扩张,最大直径为 7cm;然而,评估 PBM 的存在具有挑战性。超声内镜显示扩张的胆总管内有小胆石和碎片,胆囊壁无增厚。内镜逆行胰胆管造影未见 PBM 或显著升高的胆汁淀粉酶水平。基于这些发现,患者被诊断为 Todani Ib 型 CBD。由于该患者没有胰胆管反流,尚不清楚其发生胆道癌的风险是否较高,且由于治疗具有高度侵袭性,决定不进行手术治疗而随访观察。