Choledochocele: Choledochal Cyst Ora Distinct Entity?

Choledochocele represents a cystic dilatation of the distal common bile duct and it’s included in Todani’s classification as type III choledochal cysts. We report a case of a 66-years-old man who presented a suspected gallbladder lithiasis with colic abdominal pain, vomit, fever, jaundice and abnormal liver function tests. However the endoscopic retrograde cholangio-pancreatography revealed the absence of stones in the common bile duct and the presence of a 15mm-wide choledochocele that was successfully treated with an endoscopic sphincterotomy. Additionally a comprehensive review of the literature of the last 15 years was performed, collecting 105 cases of choledochocele. The available data were classified in 10 variables and subsequently analysed. Summarizing all data, we noticed that choledochocele presents different characteristics if compared with other types of choledochal cysts: The population affected is older, there isn’t a strong female prevalence, the most frequent manifestation is pancreatitis instead of jaundice and cholangitis, the association with anomalous pancreato-biliary duct junction is rare and the risk of malignancy is lower. The standard for the diagnosis is endoscopic retrograde cholangio-pancreatography instead of magnetic resonance cholangio-pancreatography and the most accepted treatment is endoscopic sphincterotomy in order to allow the correct outflow of the biliary juice. In conclusion, even if choledochocele is commonly considered a type of cystic dilatation of the common biliary duct and it is usually included in the choledochal cysts classification, it has to be considered as a distinct entity with its own features.