CONTRIBUTION OF MR-CHOLANGIOGRAPHY FOR TH E DIAGNOSIS OF CYSTIC DILATION OF THE MAIN BILE-DUCT

BACKGROUND: Magnetic resonance cholangiography is a noninvasive method for exploring the biliary and pancreatic ducts. Allergic risk is redu ced as no contrast agent is required and there is no risk of infectiou s contamination due to catheterism. Unlike endoscopic retrograde chola ngiography which requires anesthesia, there is no risk of morbidity. W e report one observation of Todani type Ia cystic dilatation of the ma in bile duct explored preoperatively with MR-cholangiography. CASE REP ORT: A 39-year-old woman complained of acute abdominal pain. Physical examination revealed jaundice and fever. MR-cholangiography gave the d iagnosis of angiocholitis with cystic dilatation of the main bile duct (type Ia). Surgery was indicated. The procedure included a Y-loop hep ato-jejunal anastomosis and cholecystectomy. The postoperative period was uneventful. Pathology reported a cystic formation with no signs of malignancy. DISCUSSION: Common manifestations of congenital cystic di latation of the main bile duct are biliary pain, fever and jaundice. T he MR-cholangiogram provides a map of the bile duct system directly wi th a noninvasive procedure. The map may be obtained in several planes to guide surgery. Indeed, since cholangiocarcinoma is found in numerou s cases, surgery is a formal indication in patients with angiocholitis . (C) 1998, Masson, Paris.