A Case Report of Type IV-A Congenital Dilatation of Bile Duct with Severe Acute Pancreatitis

Ippei Matsumoto, Tetsuo Ajiki, Hidehiro Sawa, Tsunenori Fujita, Takashi Ueda, Yasuhiro Fujino, Yasuyuki Suzuki and Yoshikazu Kuroda

Department of Gastroenterological Surgery, Kobe University, Graduate School of Medical Sciences

The congenital cysts of the bile duct and anomalous pancreaticobiliary junction often present with acute pancreatitis, but the pancreatitis grade in most cases is mild. We report a type IV-A congenital dilatation of bile duct with severe acute pancreatitis. A 68-year-old woman admitted for severe acute pancreatitis. After treatment for acute pancreatitis, MRCP and ERCP were done, showing a type IV-A congenital dilatation of bile duct. The dilated choledochus was excised and hepaticojejunostomy was conducted 6 weeks after pancreatitis onset. During surgery, we could not dissect the intrapancreatic bile duct due to changes from pancreatitis, so we dissected the bile duct at the upper edge of the pancreas. Congenital dilatation of bile duct of bile duct and anomalous pancreaticobiliary junction must thus be considered as a possible cause of severe acute pancreatitis. Surgical timing should be delayed until pancreatitis changes disappear if the congenital dilatation of bile duct is to be resected once the absence of malignancy has been confirmed.

Key words
congenital dlilatation of bile duct, acute pancreatitis, anomalous pancreaticobiliary junction

Reprint requests
Ippei Matsumoto Department of Gastroenterological Surgery, Kobe University, Graduate School of Medical Sciences
7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 JAPAN

Accepted
September 28, 2005

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