Pyogenic granuloma of the common bile duct in a patient with choledochoduodenostomy.

capillary hemangioma that occurs mostly on the skin and the mucous membranes of the nasal and oral cavities [1]. Al− though pyogenic granuloma in the diges− tive tract excluding the oral cavity is a rar− ity, it can cause significant gastrointesti− nal bleeding, and curative resection is re− quired for treatment in most cases [2]. We describe a case of pyogenic granulo− ma of the common bile duct (CBD) that was observed on endoscopy and was suc− cessfully treated by endoscopic snare po− lypectomy. A 69−year−old woman was admitted to our hospital with a 1−day history of right upper quadrant pain. She had a history of cholecystectomy and CBD exploration with side−to−side choledochoduodenos− tomy and recurrent attacks of cholangitis. On endoscopic retrograde cholangiogra− phy (ERC) using an Olympus duodeno− scope (JF−240; Olympus Optical Co., To− kyo, Japan), the CBD was cannulated with a balloon catheter through the wide stoma of the side−to−side choledochoduo− denostomy (l" Fig. 1 a) and the CBD visu− alized. A nonmovable, small, round filling defect was noted in the dilated distal CBD (l" Fig. 1 b). Because of the wide stoma of the choledochoduodenostomy and the di− lated CBD, it was possible to insert a for− ward−viewing endoscope (Olympus GIF− Q260; Olympus Optical Co.) through the stoma into the distal CBD. This showed a semipedunculated, smooth polypoid lesion that was 5 mm in diameter, hy− peremic, and dark red in the distal CBD, with a tinge of blood on its surface (l" Fig. 2 a). The lesion was removed by snare polypectomy without any compli− cations (l" Fig. 2 b). On the basis of histo− pathological analysis of the resected tis− sue (l" Fig. 3), the lesion was diagnosed as a pyogenic granuloma. To the best of our knowledge, this is the first reported case of pyogenic granuloma in the bile duct.