A 74-year-old Japanese housewife was shown to have a large, smooth-surfaced, protruding,
semipedunculated tumor covered with the normal-appearing mucosa on the posteromedial wall of the
mid descending part of the duodenum immediately oral to the papilla of Vater by endoscopy. ERCP
demonstrated the normal main and accessory pancreatic ducts. Just after abruptly contracted, the
terminal common bile duct [CBD] showed a piriform dilatation correspondent to the duodenal tumor
and tapered off to drain into the duodenal lumen without forming a common channel but through the
same papillary orifice with the main pancreatic duct [MPD]. She was diagnosed with choledochocele
unclassifiable by Sarris’s categorization. Even fully distended by infusion of contrast medium, the cyst
did not compress the MPD. Remaining asymptomatic, the lesion was left untreated. She has kept an
uneventful course for 4 years ever since. It is important to characterize the topographic relationships
of the cyst among the surrounding structures in order to definitely classify the anomaly and to predict
development of probable complications by analyzing the serial images of ERCP.
Department of Internal Medicine, Shiogama City Hospital, Shiogama, Japan.
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