Unelicited pressure: dynamic physiologic distention of a choledochocele visualized endosonographically

A 75-year-old man reported a self-limited 2-day episode of dark urine and biliary pain, without pancreatitis. Liver function tests were normal. EGD and EUS showed a normal major papilla. (A). The gallbladder harbored microlithiasis. The common bile duct (CBD) measured 6 mm and drained separately from the pancreatic duct. During inspection, coinciding with a gush of bile, gradual cystic swelling of the distal CBD occurred, ≤10 mm, below the sphincter muscle and above the papilla of Vater (B, C).