Biliary diverticulum with pancreaticobiliary maljunction

The case of a 48-year-old Japanese man with a biliary diverticulum (type B by the so-called Alonso-Lej classification) accompanied by pancreaticobiliary maljunction is reported on herein. The patient had epigastric distress, and an ultrasound examination suggested gallstones and adenomyomatosis of the gallbladder. Subsequent endoscopic retrograde cholangiopancreaticography demonstrated a 3 mm biliary diverticulum in the intrahepatic bile duct and pancreaticobiliary maljunction. Intra-operative cholangiography confirmed both the diverticulum and the pancreatiocobiliary maljunction. Cholecystectomy alone was performed. The histological diagnosis of the gallbladder was adenomyomatosis with intramural calculi. Except for continuing mild hyperamylasemia, the patient has been doing well for 18 months following surgery. To our knowledge, only two cases, of type B bile duct dilatation with pancreaticobiliary maljunction, including ours, have been reported in the English and Japanese literature. The size of the diverticulum in our case was smaller than in the other reported case. The relationship between pancreaticobiliary maljunction and type B bile duct dilatation is discussed.