Kim M H, Myung S J, Lee S K, Yoo B M, Seo D W, Lee M H, Jung S A, Kim Y S, Min Y I
Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Gastrointest Endosc. 1998 Sep;48(3):258-62. doi: 10.1016/s0016-5107(98)70187-7.
Choledochocele is a rare abnormality involving the intramural segment of the common bile duct. ERCP is essential to demonstrate a choledochocele. The aim of this study was to investigate the duodenoscopic and cholangiographic findings during ERCP.
Over a 4-year period, 17 symptomatic patients (8 men, 9 women; age range 45 to 83 years) were identified as having choledochoceles. The diagnosis of choledochocele was made by both duodenoscopic and cholangiographic findings.
As a characteristic duodenoscopic finding, the enlarged bulging papilla was noted in 8 patients (47%), whereas a normal-appearing papilla was noted in 9 patients (53%) before the injection of contrast media. However, in all 17 patients progressive enlargement or ballooning of the papilla was noted during contrast injection. The maximum 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).
Ballooning of the papilla during contrast injection may be a specific duodenoscopic finding for choledochocele. To avoid missing the diagnosis of a choledochocele, especially when it is small, it is important to watch the papilla carefully during contrast injection.
胆总管囊肿是一种涉及胆总管壁内段的罕见异常。内镜逆行胰胆管造影术（ERCP）对于显示胆总管囊肿至关重要。本研究的目的是调查ERCP期间的十二指肠镜检查和胆管造影结果。
在4年期间，确定17例有症状的患者（8例男性，9例女性；年龄范围45至83岁）患有胆总管囊肿。胆总管囊肿的诊断通过十二指肠镜检查和胆管造影结果共同做出。
作为特征性的十二指肠镜检查发现，8例患者（47%）可见肿大隆起的乳头，而在注射造影剂前，9例患者（53%）可见外观正常的乳头。然而，在所有17例患者中，在注射造影剂期间均可见乳头逐渐增大或呈气球样改变。经胆管造影确定，最初乳头隆起的患者胆总管囊肿的最大直径（19±4mm）显著大于乳头外观正常的患者（9±3mm）（p<0.05）。
注射造影剂期间乳头呈气球样改变可能是胆总管囊肿特异性的十二指肠镜检查发现。为避免漏诊胆总管囊肿，尤其是当其较小时，在注射造影剂期间仔细观察乳头很重要。
