Clin Endosc.  2021 Mar;54(2):285-288. 10.5946/ce.2020.167.

A Case of Congenital Common Bile Duct Web Treated with Balloon Dilation under Endoscopic Retrograde Cholangiopancreatography in a Young Child

Affiliations
  • 1Department of Pediatrics, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea
  • 2Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
  • 3Department of Internal Medicine, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju, Korea

Abstract

Web in common bile duct (CBD web) is very rare. It is usually asymptomatic and detected incidentally during surgery for other causes in adults. It can be congenital or acquired, however congenital CBD web is extremely rare. Currently, despite its invasiveness and complications, endoscopic retrograde cholangiopancreatography (ERCP) is considered as a useful diagnostic and therapeutic modality in children with hepatobiliary pancreatic diseases as in adults. Herein we report a case of congenital CBD web presenting with acute pancreatitis and choledocholithiasis in a 4-year-old girl which was diagnosed and treated using balloon dilation under ERCP. After balloon dilation of the web, a common pancreatobiliary channel was observed. To the best of our knowledge, a case of congenital CBD web with pancreatobiliary junctional abnormality treated using ERCP in a child has not been reported to date.

Keyword

Common bile duct; Congenital; Endoscopic retrograde cholangiopancreatography; Web

Figure

  • Fig. 1. Abdominal radiologic studies show the dilated intrahepatic and common bile duct (CBD) with 0.94 cm in diameter (A), and a 4.7-mm-sized echogenic material in the distal CBD (B) on abdominal ultrasonography. Pancreaticobiliary computed tomography reveals a web-like structure (arrow) in the CBD (C).

  • Fig. 2. Squashed muddy stone from the common bile duct (CBD) is extracted by endoscopic balloon dilation (A). Endoscopic retrograde cholangiography shows dilated proximal bile ducts and a narrowing and a shelf-like linear contrast shadow (white circle) in the distal CBD (B). Balloon dilation of the bile duct is performed to dilate the orifice and stricture of the CBD (C). Cholangiography after CBD dilatation shows dilated stricture and a common channel (red circle) with the pancreatic duct (red arrow, D). Abnormal pancreaticobiliary junction is noted.

  • Fig. 3. Marked dilated intrahepatic and extrahepatic duct (1.63 cm in diameter) is shown on abdominal ultrasonography, when the patient was re-admitted (A). Endoscopic retrograde cholangiography shows a tight stricture and filling defects in the common bile duct (B). After recanalization, the dilated extrahepatic duct is improved to 0.67 cm in diameter (C).


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