A Case of Double Common Bile Duct with Choledocholithiasis Treated by Endoscopic Lithotripsy Using the Rendezvous Technique

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  • ランデブー法ERCPで胆管切石を行った重複胆管の1例
  • 症例 ランデブー法ERCPで胆管切石を行った重複胆管の1例
  • ショウレイ ランデブーホウ ERCP デ タンカン キリイシ オ オコナッタ チョウフクタンカン ノ 1レイ

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Double common bile duct is an extremely rare biliary anomaly. It presents a variety of morphologies in branching of the bile duct and is associated with biliary lithiasis in half of such individuals.<BR>A 69-year-old man complaining of right hypochondralgia was pointed out having gallbladder stone by abdominal ultrasonography and was referred to our hospital for the purpose of surgery. Following preoperative magnetic resonance chorangiopancreatography (MRCP) and drip infusion cholangiographic-computed tomography (DIC-CT), double common bile duct with choledocholithiasis was diagnosed. Endoscopic retrograde cholangiopancreatography (ERCP) was attempted, but selective canulation was impossible due to associated anomalous pancreaticobiliary junction. The patient developed serious pancreatitis after the operation. Since the diameter of the bile duct was as thin as 4 mm, incision and reconstruction of the bile duct had to be avoided, and the double common bile duct should not be injured during surgery, lithotripsy using the rendezvous technique was planned. Eight weeks after the onset of pancreatitis, laparoscopic cholecystectomy was initiated, but it was converted to open surgery because his pancreatitis was very serious. While intraoperative cholangiography was conducted after removal of the gallbladder, a guide wire was led to the duodenum through the surgical stump of the bile duct and endoscopic papillary balloon dilation (EPBD) was performed for lithotripsy. The patient was discharged from our hospital without having complications on the ninth postoperative day.<BR>The rendezvous technique is a beneficial treatment of option to avoid intraoperative biliary injury.

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