A Case of Choledochocele Associated with an Ampullary Carcinoma

Masaru Sasaki, Naokuni Tatsumoto, Takeshi Kobayashi, Hiroyuki Naito, Yoshiki Kai, Yoshiaki Murakami* and Taijiro Sueda*

Department of Surgery, Miyoshi Central Hospital
Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University*

We report a very rare case of choledochocele associated with an ampullary carcinoma. A 62-year-old woman was admitted for epigastralgia. Abdominal CT showed a cystic lower end of the distal common bile duct. Duodenoscopy demonstrated a soft spherical mass proximal to the ampullary orifice. The mass was covered by normal-appearing duodenal mucosa. ERCP delineated an irregularly protruded lesion at the dilated terminal end of the common bile duct. The contrast medium entered into the pancreatic duct and then into the common bile duct consecutively. PTC revealed a cyst-like, contrast-filled structure at the terminal end of the common bile duct. A cystic lesion draining into the pancreatic duct had formed a short common channel. An irregularly protruding lesion was delineated similarly to ERCP. We conducted a pylorus-preserving pancreaticoduodenectomy under the diagnosis of a suspected choledochocele associated with an ampullary carcinoma. Histopathological examination revealed a moderately differentiated tubular adenocarcinoma arising from the bile duct of the ampulla and moderate dysplasia in the mucosa of the common bile duct. Though a choledochocele should be readily treated under an endoscopic technique, we must be aware that a carcinoma may develop in a choledochocele.

Key words
choledochocele, ampullary carcinoma, choledochal cyst

Reprint requests
Masaru Sasaki Department of Surgery, Miyoshi Central Hospital
531 Higashisakeyamachi, Miyoshi, 728-8502 JAPAN

Accepted
November 30, 2005

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