Incomplete resection of
choledochal cysts (CCs) that extend deep into the
pancreas can
lead to
protein plug or stone formation,
pancreatitis, and
cholangiocarcinoma. We encountered two cases of
choledocholithiasis in remnant intrapancreatic CCs, in which the
patients exhibited symptoms after 3 and 21 years of
cyst excision. A 21-year-old
woman who had undergone excision of a CC, as a
neonate, presented with epigastric
pain. Abdominal computed
tomography (CT) revealed stones inside the remnant
pancreatic cyst, which were removed by
endoscopic retrograde cholangiopancreatography (
ERCP), and her symptoms improved. A 33-year-old
woman,
who underwent
cyst excision 3 years ago, presented with
pancreatitis. Abdominal CT showed a radiolucent plug inside the remnant
pancreatic cyst. The soft, whitish plug was removed by
ERCP, and the
pancreatitis improved. These cases indicate that plugs and stones in CCs have the same pathogenetic mechanism, and their form depends on the
time since the incomplete excision
surgery.