Preoperative endoscopic extraction of a huge pancreatic protein plug in a choledochal cyst: A case report

A 4-year-old female was referred to our institution with acute pancreatitis due to a choledochal cyst. A protein plug was found to be deeply impacted in the main pancreatic duct. She underwent preoperative endoscopic retrograde cholangiopancreatography (ERCP) followed by sphincteroplasty and extraction of the protein plug with a basket extractor. After the ERCP procedure, the patient successfully underwent total choledochal cyst excision with Roux-en-Y hepaticojejunostomy. In cases in which a huge protein plug is located deep in the pancreatic duct, therapeutic ERCP is useful as preoperative management for choledochal cyst excision with hepaticojejunostomy.