A Case of Choledochocele Associated with an Adenoma of the Duodenal Papilla

Naoya Nakagawa, Masaru Sasaki, Takeshi Kobayashi, Hiroyuki Naito, Junji Hashizume, Makoto Ochi, Naokuni Tatsumoto, Hiroki Kuniyasu¹⁾, Yoshiaki Murakami²⁾ and Taijiro Sueda²⁾

Department of Surgery and Department of Pathology¹⁾, Miyoshi Central Hospital
Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University²⁾

We report a rare case of choledochocele associated with an adenoma of the duodenal papilla. A 81-year-old man admitted for epigastralgia was found in abdominal computed tomography (CT) and magnetic resonance cholangiopancreaticography (MRCP) to have a cystic lower end of the distal common bile duct. Upper gastrointestinal endoscopy showed a soft spherical mass proximal to the ampullary orifice. The papilla was covered by granular duodenal mucosa and histopathological examination showed a tubular adenoma. We conducted a transduodenal sphincterotomy and sphincteroplasty under a diagnosis of suspected choledochocele associated with adenoma of the duodenal papilla. In many cases, a choledochocele should be readily treated endoscopically. Our choledochocele associated with ampullary adenoma, however, was difficult to distinguish preoperatively from choledochocele associated with carcinoma. Physicians should thus be aware that carcinoma may develop in a choledochocele. Due to the possibility of malignant changes already induced, the ampullary mucosa should be observed for several years even after endoscopic treatment or surgery.

Key words
choledochocele, ampullary adenoma, choledochal cyst

Reprint requests
Naoya Nakagawa Department of Surgery, Miyoshi Central Hospital
531 Higashisakeyamachi, Miyoshi, Hiroshima, 728-8502 JAPAN

Accepted
May 27, 2009

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