Endoscopic retrograde cholangiopancreatography (ercp) in a patient with choledochal duplication

Introduction: A 61-year-old patient with a history of cholecystectomy for symptomatic cholelithiasis and recurrent cholangitis episodes. In the first episode, MRI confirmed choledocholithiasis, and during ERCP, a long duct parallel to the common bile duct was observed, likely representing a low-implantation cystic duct. A follow-up MRI during a new cholangitis episode showed a bifurcation of the extrahepatic/common bile duct and a stone in the common hepatic duct, prompting repeat ERCP.

Ercp: The papilla was peridiverticular with prior sphincterotomy. Selective bile duct cannulation was performed using a 0.035 guide wire. Initial cholangiography showed a non-dilated intrahepatic bile duct but with changes in the left intrahepatic bile duct (likely from cholangitis). The common hepatic duct was dilated (10 mm) with a filling defect, suggestive of a stone. The study revealed choledochal duplication (two 5 mm bile ducts) merging into a common distal bile duct of 3 cm. This was consistent with Choi’s type Vb choledochal duplication. Multiple cleaning maneuvers were performed using saline irrigation and a Fogarty balloon catheter, clearing bile mud and calcium bilirubinate microlithiasis. After multiple passes, the balloon was removed without difficulty.

Conclusions: Choledochal duplication, subtype Vb (Choi classification), is a rare congenital anomaly that can lead to recurrent cholangitis and may increase the risk of cholangiocarcinoma.

Publication History

Article published online:
27 March 2025