Choledochocele - A rare cause of necrotising pancreatitis in childhood

Recurring complaints of unknown origin in the upper abdomen during childhoo d are not frequent. Choledochoceles, or type III choledochal cysts, are rar e congenital abnormalities of unclear aetiology. They are rarely considered in the differential diagnosis of upper abdominal symptoms in childhood. On ly 130 cases of choledochoceles have been reported in world literature to d ate. Only 20% of these patients were children or adolescents. The symptoms do not specifically suggest a choledochocele, and are usually attributed to other disorders of the upper intestinal tract, frequently resulting in a d elayed diagnosis. We present the case of a 10-year old girl in whom a congenital choledochoce le was diagnosed by gastro-intestinal studies and endoscopic retrograde cho langiopancreatography (ERCP) following a 2-years history of recurrent pancr eatitis. Various types of choledochoceles are presented in the literature, classified according to morphology and histology. Most authors consider the m to be a form of choledochal cyst. Their embryonic development is related to that of congenital duodenal diverticula. Although congenital intralumina l duodenal dilatations are of known oncogenic significance, only two cases of adenocarcinoma arising from a choledochocele have been described to date . Established treatment of large choledochoceles in childhood is transduode nal marsupialization.