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[Common bilio-pancreatic channel. Apropos of a case with intermittent dilatation of the biliary tracts].

BACKGROUND
A common biliopancreatic channel can be revealed by cholestatic episodes. Its early removal avoids the development of liver cirrhosis and the risk of carcinomatous change.


CASE REPORT
A 2 year 9 month-old girl had suffered from jaundice plus dark urine and pale stools for 2 months. A similar episode occurred 7 months later. Ultrasonography showed moderate dilatation of the intra and extrahepatic bile ducts that disappeared a few weeks later. A third episode of cholestasis with moderate dilation of the bile ducts occurred at the age of 3 year 11 months, complicated 2 weeks later by abdominal pain, vomiting and abdominal distension. Her serum amylase activity was 1,380 IU/l (N < 82). Ultrasonography and CT scan showed moderate dilation of the common hepatic duct. Liver biopsy showed pathological features consistent with bile obstruction. Endoscopic retrograde choledocopancreatography showed a long common channel with dilated extra and intrahepatic bile ducts, an incomplete pancreas divisum and numerous intracanalar stones. A sphincterotomy was performed and stones were extracted. The patient is well 18 months after surgery, with normal laboratory and ultrasonographic profiles.


CONCLUSION
A common biliopancreatic channel is often associated with choledocal cyst. Whether development of the cyst is preceded by intermittent dilation of the bile ducts, as in this case, remains to be determined.