Image of the Month—Diagnosis | Hepatobiliary Disease | JAMA Surgery | JAMA Network
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Special Feature
Oct 2011

Image of the Month—Diagnosis

Arch Surg. 2011;146(10):1213. doi:10.1001/archsurg.2011.263-b

Choledochocele is a rare type of choledochal cyst (type III according to Todani classifications1) characterized by cystic dilatation of the bile duct terminal and protrusion of the papilla of Vater into the duodenal lumen.2 This anomaly has a prevalence of 0.3% to 0.4% among endoscopic retrograde cholangiopancreatography recipients and 1% to 5% among choledochal cysts.3

Horaguchi et al2 have proposed a practical classification of choledochoceles into 2 types. In type I, the bile duct terminal forms a choledochocele and opens to the duodenum independently from the pancreatic duct or forms a very short common channel with the pancreatic duct. In type II, the pancreatic duct opens to the choledochocele. Type II occurs in 10% of choledochoceles and represents an anomalous arrangement of the pancreatobiliary ductal systems.2