Clin Endosc.  2017 Sep;50(5):504-507. 10.5946/ce.2017.012.

Two Cases of Plug or Stone in Remnant Intrapancreatic Choledochal Cysts Treated with Endoscopic Retrograde Cholangiopancreatography

• Kim E
• Kang MH
• Lee J
• Choi H
• Choi JW
• Han JH
• Park SM

• KMID: 2394753
• DOI: http://doi.org/10.5946/ce.2017.012

Abstract

Incomplete resection of choledochal cysts (CCs) that extend deep into the pancreas can lead to protein plug or stone formation, pancreatitis, and cholangiocarcinoma. We encountered two cases of choledocholithiasis in remnant intrapancreatic CCs, in which the patients exhibited symptoms after 3 and 21 years of cyst excision. A 21-year-old woman who had undergone excision of a CC, as a neonate, presented with epigastric pain. Abdominal computed tomography (CT) revealed stones inside the remnant pancreatic cyst, which were removed by endoscopic retrograde cholangiopancreatography (ERCP), and her symptoms improved. A 33-year-old woman, who underwent cyst excision 3 years ago, presented with pancreatitis. Abdominal CT showed a radiolucent plug inside the remnant pancreatic cyst. The soft, whitish plug was removed by ERCP, and the pancreatitis improved. These cases indicate that plugs and stones in CCs have the same pathogenetic mechanism, and their form depends on the time since the incomplete excision surgery.

Keyword

Choledochal cyst, intrapancreatic remnant; Cholelithiasis; Acute pancreatitis; Abdominal pain

MeSH Terms

Abdominal Pain
Adult
Cholangiocarcinoma
Cholangiopancreatography, Endoscopic Retrograde*
Choledochal Cyst*
Choledocholithiasis
Cholelithiasis
Female
Humans
Infant, Newborn
Pancreas
Pancreatic Cyst
Pancreatitis
Tomography, X-Ray Computed
Young Adult

Figure

• 

  Fig. 1. Imaging of the stone in the remnant intrapancreatic choledochal cyst in case 1. (A) Axial view, (B) Coronal view. Abdominal computed tomography scan showing a round cystic lesion (arrowheads) with round stones (arrow) in the pancreatic head. (C) Endoscopic ultrasonogram showing a hypoechoic cyst (arrow) containing hyperechogenic stones with acoustic shadows (asterisks) in the pancreatic head. (D) A round stone removed using mechanical lithotripsy. (E, F) Whitish, hard protein stones removed using a basket.

• 

  Fig. 2. Imaging of the plug in the remnant intrapancreatic choledochal cyst in case 2. (A) Axial view, (B) Coronal view. Abdominal computed tomography scan showing a round cystic lesion (arrowhead) with a round radiolucent lesion (arrow) in the pancreatic head. (C) Endoscopic ultrasonogram showing a hypoechoic cyst (arrow) containing a hyperechogenic lesion without acoustic shadows in the pancreatic head. (D) Endoscopic retrograde cholangiopancreatography showing cystic pooling with filling defects. (E, F) A soft, white plug removed using a balloon catheter and basket.

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