case_images: PMC11750419_01
case_images: Dilatation of the choledochus with an image that could correspond to calculus (only visualized in a sequence). However, there is an abrupt termination of the choledochus and saccular dilatations of the intrahepatic biliary tract, so it is not possible to rule out periampullary lesions. Endoscopic evaluation is suggested. The small cystic lesion of the body of the pancreatic head could correspond to intraductal papillary mucinous intraductal neoplasm with no ominous signs. Cysts are simple hepatic cysts.
case_images: 10-1055-a-2499-7279_24997945.jpg
case_images: PMC11750419_01_10-1055-a-2499-7279_24997945.jpg
case_images: FI_Ref185328126
case_images: Magnetic resonance imaging (MRI) showed no evidence of neoplasia and a dilatation of the choledochus and intraductal image ( Fig. 1 ). Endoscopic retrograde cholangiopancreatography and cholangioscopy was then performed using direct visualization by SpyGlass (Boston Scientific, Marlborough, Massachusetts, USA) in which multiple subepithelial, rounded and translucent lesions corresponding to cysts were observed, some of which ruptured spontaneously during the procedure ( Fig. 3 , Video 1 ).
case_images: Pancreatic head cyst measuring 6x9 mm, without communication with the main or secondary pancreatic duct. 7 mm choledochus with micro calculus of 2 mm inside. Papilla are endoscopically and endosonographically normal.
case_images: 10-1055-a-2499-7279_24997946.jpg
case_images: PMC11750419_01_10-1055-a-2499-7279_24997946.jpg
case_images: FI_Ref185328192
case_images: Echo-endoscopy showed only an image suggestive of a 2-mm stone in the choledochus ( Fig. 2 ).
case_images: Cholangiopancreatography
  :
  Multiple filling defects at the level of the middle choledochus, proximal choledochus, right and left hepatic duct, with dilated intra- and extra-hepatic biliary tract. Cholangioscopy
  :
  Multiple subepithelial, rounded, translucent lesions corresponding to cysts, some of which rupture spontaneously. At the level of the left hepatic duct, there is a cyst that generates partial occlusion of two ducts that is broken by SpyBite forceps.
case_images: 10-1055-a-2499-7279_24997947.jpg
case_images: PMC11750419_01_10-1055-a-2499-7279_24997947.jpg
case_images: FI_Ref185328195
case_images: Endoscopic retrograde cholangiopancreatography and cholangioscopy was then performed using direct visualization by SpyGlass (Boston Scientific, Marlborough, Massachusetts, USA) in which multiple subepithelial, rounded and translucent lesions corresponding to cysts were observed, some of which ruptured spontaneously during the procedure ( Fig. 3 , Video 1 ).