Anatomic Variants of Choledochocele and Manometric Measurements of Pressure in the Cele and the Orifice Zone

We report five cases of choledochocele and propose five anatomic variants (types A-E) on the basis of endoscopic retrograde cholangiography findings. To clarify pathophysiology of the disease manometric studies were performed in the three cases. As a result, the orifice of the cele was proved to act like a sphincter. Two of them with normal motility of the orifice showed normal pressures in the cele. However, one case with spastic motility of the orifice showed high pressure in the cele. All five cases had chronic pancreatitis. In a case (type E) without communication between the cele and the pancreatic duct, the cause of pancreatitis seemed to be increased pancreatic ductal pressure due to disturbed motility of an inflamed pancreatic sphincter. In the other four cases with communication between the cele and the pancreatic duct, the cause of pancreatitis may be a reflux of bile juice into the pancreatic duct. Manometric study seems to be useful in clarifying the pathophysiology of choledochocele.