Common bile duct web: Managed with excision and primary anastomosis of bile duct over ERCP stent

Abstract

Congenital biliary web formations are extremely rare, with only a few cases reported till date in the literature. We report a case of a four years old female child, presented to us for evaluation of jaundice and recurrent attacks of cholangitis. Intra-operatively, we found a nodular mass near the distal end of common bile duct causing extrinsic compression on extra-hepatic biliary tree. Biopsy revealed reactive lymphoid hyperplasia. Four weeks after the first surgery a second procedure was planned. The child then underwent exploratory laparotomy with resection of common bile duct web and anastomosis over an ERCP (Endoscopic retrograde cholangiopancreatography) stent. The reported treatment for biliary web commonly consists of Roux-en-Y hepatico-jejunostomy, excision of the diaphragm with t-tube insertion or excision of the web with a cholecystectomy. However, we performed excision of the web and primary anastomosis of CBD (Common Bile Duct) over an ERCP stent preserving native common bile duct.