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Ballooning of the papilla during contrast injection: the semaphore of a choledochocele.

Authors
Kim, MH; Myung, SJ; Lee, SK; Yoo, BM; Seo, DW; Lee, MH; Jung, SA; Kim, YS; Min, YI
Citation
Gastrointestinal endoscopy, 48(3):258-262, 1998
Journal Title
Gastrointestinal endoscopy
ISSN
0016-51071097-6779
Abstract
BACKGROUND: Choledochocele is a rare abnormality involving the intramural segment of the common bile duct. ERCP is essential to demonstrate a choledochocele. The aim of this study was to investigate the duodenoscopic and cholangiographic findings during ERCP.



METHODS: Over a 4-year period, 17 symptomatic patients (8 men, 9 women; age range 45 to 83 years) were identified as having choledochoceles. The diagnosis of choledochocele was made by both duodenoscopic and cholangiographic findings.



RESULTS: As a characteristic duodenoscopic finding, the enlarged bulging papilla was noted in 8 patients (47%), whereas a normal-appearing papilla was noted in 9 patients (53%) before the injection of contrast media. However, in all 17 patients progressive enlargement or ballooning of the papilla was noted during contrast injection. The maximum diameter of the choledochocele, determined by cholangiography, was significantly larger (19 +/-4 mm) in patients with initially bulging papilla than in those with normal-appearing papilla (9+/-3 mm) (p < 0.05).



CONCLUSIONS: Ballooning of the papilla during contrast injection may be a specific duodenoscopic finding for choledochocele. To avoid missing the diagnosis of a choledochocele, especially when it is small, it is important to watch the papilla carefully during contrast injection.
MeSH terms
AgedAged, 80 and overCholangiographyCholangiopancreatography, Endoscopic Retrograde/*methodsCholedochal Cyst/*diagnosis/surgeryCommon Bile Duct/abnormalitiesContrast Media/administration & dosageDiagnosis, DifferentialDuodenoscopy/*methodsFemaleFollow-Up StudiesHumansInjections, IntralesionalMaleMiddle AgedSensitivity and SpecificitySphincterotomy, EndoscopicStatistics, NonparametricTreatment Outcome
PMID
9744600
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Gastroenterology
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