| A Case of Choledochal Cyst Type IVa Complicated by Multiple Choledocholithiasis and Recurrent Cholangitis : Therapeutic Endoscopic Retrograde Cholangiopancreatography and Endoscopic Nasobiliary Drainage |
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Yong Joo Kim1, Eon Woo Shin1, Soo Jung Choi1, Ho Soon Choi2, Jeh Hoon Shin1 |
1Department of Pediatrics, College of Medicine, Hanyang University, Seoul, Korea
2Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea |
| 제 IVa형 총담관 낭종에 동반된 담관 결석 및 화농성 담관염에서 경구경유두적 담석제거술 및 경비담관 담석제거술 및 경비담관 |
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김용주1, 신언우1, 최수정1, 최호순2, 신재훈1 |
1한양대학교 의과대학 소아과학교실
2한양대학교 의과대학 내과학교실 |
Correspondence:
Jeh Hoon Shin, Email: 1
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| Abstract |
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A 5-year-old male patient was admitted due to fever, and right upper abdominal pain for 2 weeks.
He showed severe right upper quadrant tenderness on palpation, hepatomegaly 5 cm below the
right costal margin, no mass, and no splenomegaly. On biochemical studies, ALT was 380IU/ml,
AST 462IU/ml, alkaline phosphatase 1,069IU/ml, γGTP 239IU/ml, and total bilirubin 2.1mg/dl. Endoscopic
retrograde cholangiopancreatography (ERCP) showed cylindrical dilatations of CBD and cystic
dilatations with strictures of extrahepatic and both bilateral intrahepatic bile ducts (choledochal
cyst type IVa) with multiple stones in the CBD and extra- and intrahepatic bile ducts. Endoscopic
sphincterotomy(EST) and stone extraction with basket and balloon were performed successfully.
The bile was severely purulent and the stones were pigment stones. Klebsiella pneumoniae were
dominantly grown on bile culture. An endoscopic nasobiliary drainage (ENBD) tube was inserted to
treat biliary sepsis. The bile ducts were irrigated with tobramycin-mixed normal saline twice a day
for 2 week, when ALT, AST, total bilirubin and liver size were normalized and no more bacteria
was grown on bile culture. The clinical symptoms were improved just after the therapeutic ERCP.
There was no side effect by ERCP, EST and ENBD. |
| Key Words:
Choledochal cyst Type IVa, Choledocholithiasis, Acute cholangitis, ERCP, EST, ENBD |
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