Korean J Hepatobiliary Pancreat Surg.  2015 Aug;19(3):121-124. 10.14701/kjhbps.2015.19.3.121.

A case of gallbladder cancer combined with ectopic individual opening of pancreatic and bile ducts to the duodenal bulb

• Lee W
• Park JH
• Kim JY
• Kwag SJ
• Park T
• Jeong SH
• Ju YT
• Jung EJ
• Lee YJ
• Choi SK
• Hong SC
• Jeong CY

• KMID: 2043288
• DOI: http://doi.org/10.14701/kjhbps.2015.19.3.121

Abstract

Ectopic opening of the pancreatic and bile ducts (EOPBD) into the duodenal bulb is an extremely rare congenital anomaly with unknown clinical implications. We presented a case of gallbladder cancer with EOPBD into the duodenal bulb. A 57-year-old male was referred to our hospital with intermittent right upper abdominal pain. Endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography showed individual EOPBD into the duodenal bulb with no papillary structure, and a focal nodular lesion in the gallbladder. A follow-up abdominal computed tomography scan 9 months later revealed a slight increase in the size of the fundal nodule, which was suspected as gallbladder cancer. An intraoperative frozen biopsy identified the nodular lesion as adenocarcinoma involving the cystic duct, and the patient underwent radical cholecystectomy including bile duct resection with hepaticojejunostomy. EOPBD is an extremely rare condition that can be associated with gallbladder malignancy as well as benign disease. Clinicians should follow up carefully and consider surgical treatment for suspected malignant lesions.

Keyword

Ectopic opening; Gallbladder cancer; Pancreatic duct; Bile duct

MeSH Terms

Abdominal Pain
Adenocarcinoma
Bile Ducts*
Bile*
Biopsy
Cholangiopancreatography, Endoscopic Retrograde
Cholangiopancreatography, Magnetic Resonance
Cholecystectomy
Cystic Duct
Follow-Up Studies
Gallbladder Neoplasms*
Gallbladder*
Humans
Male
Middle Aged
Pancreatic Ducts

Figure

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  Fig. 1 Endoscopy shows ectopic individual openings of the pancreatic and bile ducts into the duodenal bulb.

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  Fig. 2 Magnetic resonance cholangiopancreatography shows independent insertion of the pancreatic and bile ducts, without pancreatobiliary union.

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  Fig. 3 Macroscopic view shows thickening of the wall of the gallbladder fundus.

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  Fig. 4 Histologic findings of the gallbladder. There is invasion of moderately differentiated adenocarcinoma into the perimuscular connective tissue, without metastatic nodes.

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