Giant Juxtapapillary Diverticulum Causing Chronic Cholestasis and Recurrent Cholangitis

Liana Gheorghe, Cristian Gheorghe, Cornelia Popescu, Iulia Simionov, Alexandra Constantinescu, Ionut Iova, Alexandru Oproiu

Center of Gastroenterology Fundeni Hospital, "Carol Davila" University of Medicine, Bucharest

Abstract

Juxtapapillary duodenal diverticula are diagnosed with increasing frequency during endoscopic retrograde cholangiopancreatography. Usually, they are less than 10 mm and do not provoke symptoms by themselves. We report the case of a 49-year-old female patient admitted with chronic cholestasis and recurrent atacks of cholangitis due to a giant juxtapapillary duodenal diverticulum containing a large phytobezoar mass and causing a distal biliary stricture of the common bile duct. Bile cultures obtained directly at the time of ERCP were positive for Enterobacter. A large sphincterotomy followed by endoscopic balloon dilatation of the common bile duct stricture was performed. Concomitantly, the patient received broad spectrum antibiotics and ursodeoxycholic acid. The outcome was rapidly favourable and the patient was discharged 12 days later.

Key words

Juxtapapillary duodenal diverticulum - cholangitis - endoscopic retrograde cholangiopancreatography