Incidental choledochocoele, imaging and endoscopic findings

Description

A 70-year-old man being investigated for weight loss was found to have an incidental cystic lesion at the level of the ampulla with a normal extrahepatic biliary tree on CT. Liver function tests were normal. MR cholangiopancreatography suggested a focal dilation of the common bile duct deemed proximal to the ampulla, suspicious for malignancy with post-stenotic dilation (figure 1). At endoscopic retrograde cholangiopancreatography , it was seen to be a bulge into the duodenum (figure 2), through which the ampulla was cannulated with a guidewire (figure 3). Biliary and pancreatic duct anatomy was seen on cholangiography (figure 4). This was in keeping with a choledochocoele. Bile duct brushings were negative for malignancy on cytology and the patient subsequently underwent endoscopic sphincterotomy with release of multiple stones; he made an uneventful recovery.

Figure 1

MRCP image showing focal dilation...

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