A Common Bile Duct Web in Association with Bile Duct Stone Treated with Balloon Dilatation

Abstract

Bile duct web is very rare disease and it's etiology is controversial. Some webs are occurred in the presence of chronic inflammation, frequently associated with bile duct stone, but others are thought to be congenital. Many patients with bile duct web are asymptomatic, but they sometimes present symptom of biliary obstruction and cholangitis. It can be diagnosed by endoscopic retrograde cholangiopancreatogram, typically appearing as thin and shelf like radiolucent ring. We report a case of the common bile duct web with bile duct stones diagnosed by Endoscopic retrograde cholangiopancreatography (ERCP) in a 65-year-old man. The patient was treated by balloon dilatation successfully.

A Case of Congenital Common Bile Duct Web Treated with Balloon Dilation under Endoscopic Retrograde Cholangiopancreatography in a Young Child

“…To date, a number of CBD web cases in adults has been reported worldwide; however, a pediatric case of congenital CBD web is rare. 1,4,[10][11][12][13] Acquired CBD web is caused by injury during biliary procedure or surgery, chronic inflamma-tion due to recurrent stones, and malignancy. 2,13 Congenital CBD web, on the other hand, is caused by incomplete biliary tract recanalization during embryogenesis, 12 and it is often accompanied by a choledochal cyst, hepatic fibrosis, and anomalous junction of the pancreaticobiliary ductal system.…”

Mechanical and Anatomical Causes of Bile Duct

“…In the few situations where histologic examination of resected webs or septa had been performed, these structures disclosed a fibrous stroma covered by ductal mucosa (Ando et al 1995), sometimes with atrophy of the overlying mucosa (Furukawa et al 1992) or, conversely, with signs of epithelial proliferation (Baek et al 2005). The resected web in one patient with biliopancreatic maljunction showed a normal histology of the adjacent parts of the common hepatic duct (Kato et al 1994).…”

“…On imaging, webs typically appear as thin radiolucent rings with or without proximal duct dilatation. Webs are predominantly located in the common hepatic duct (Fisher et al 1968;Furukawa et al 1992;Kato et al 1994), the right or left hepatic duct (Goldenberg et al 1981), the hepatic duct junction (Devanesan et al 1978), and the common bile duct (Ornet et al 1966;Pinter et al 1975;Chari and Harrison 1998;Baek et al 2005;Shera and Shah 2008).…”

“…On the other hand, there may be instances where webs or septum-like formations develop subsequent to inflammatory changes of ducts. For example, biliary web has been noted in association with cholelithiasis (de Celis et al 1985;Papaziogas et al 2002;Baek et al 2005), but gallstones may also develop as a complication of web-induced bile duct stenosis. Furthermore, webs are a cholangiographic feature in a subset of patients with primary sclerosing cholangitis (PSC;Gulliver et al 1991).…”

“…Macroscopically, the diaphragms or septa are crescent shaped, bridge-like, or shaped like a swallow's nest (aortic valve-like), or they present as ringlike webs (perforated diaphragms). At choledochoscopy, the web may show a micropapillary texture and erosions (Baek et al 2005).…”