Clin Endosc.  2015 May;48(3):260-264. 10.5946/ce.2015.48.3.260.

Ectopic Opening of the Common Bile Duct into the Duodenal Bulb Accompanied with Cholangitis and Gallbladder Cancer: A Report of Two Cases

• Lee JM
• Kim HJ
• Ha CY
• Min HJ
• Kim H
• Kim TH
• Jung WT
• Lee OJ

• KMID: 2148577
• DOI: http://doi.org/10.5946/ce.2015.48.3.260

Abstract

An ectopic opening of the common bile duct (CBD) into the duodenal bulb is a very rare congenital anomaly of the biliary system, which may cause recurrent duodenal ulcer or biliary diseases such as choledocholithiasis and cholangitis. Endoscopic retrograde cholangiopancreatography (ERCP) plays a major role in the diagnosis of this anomaly. We report two such cases: one in a 61-year-old man and the other in a 57-year-old man. In the first case, this anomaly caused acute cholangitis with multiple CBD stones, which were successfully treated by ERCP. In the second case, abdominal computed tomography showed pneumobilia, which was further evaluated using ERCP. Besides, this patient was diagnosed with an ectopic opening of the CBD associated with gallbladder cancer. We report these unusual cases and review the relevant medical literature.

Keyword

Ectopic opening; Common bile duct; Duodenal bulb; Acute cholangitis; Gallbladder neoplasms

MeSH Terms

Biliary Tract
Cholangiopancreatography, Endoscopic Retrograde
Cholangitis*
Choledocholithiasis
Common Bile Duct*
Diagnosis
Duodenal Ulcer
Gallbladder Neoplasms*
Humans
Middle Aged

Figure

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  Fig. 1 Endoscopic retrograde cholangiopancreatography showing the major papilla of Vater located in the duodenal bulb (A) and dilatation of the common bile duct with multiple floating filling defects (B).

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  Fig. 2 Endoscopic papillary balloon dilation was performed with a balloon catheter (A) and common bile duct stones were removed using a basket (B).

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  Fig. 3 Endoscopic retrograde cholangiopancreatography showing the major papilla of Vater located in the duodenal bulb (A) and mild dilatation of the common bile duct along with normal appearance of the main pancreatic duct (B).

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  Fig. 4 Contrast-enhanced computed tomography scan showing focal nodular wall thickening with enhancement (arrows) of the gallbladder in the coronal view (A) and in the axial view (B).

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  Fig. 5 Microscopic examination of the resected gallbladder showing a moderately differentiated adenocarcioma extending into the perimuscular connective tissue (A: H&E stain, ×40; B: H&E stain, ×100).

Reference

1. Kanematsu M, Imaeda T, Seki M, Goto H, Doi H, Shimokawa K. Accessory bile duct draining into the stomach: case report and review. Gastrointest Radiol. 1992; 17:27–30. PMID: 1544554.

2. Pereira-Lima J, Pereira-Lima LM, Nestrowski M, Cuervo C. Anomalaous location of the papilla of vater. Am J Surg. 1974; 128:71–74. PMID: 4834898.

3. Moosman DA. The surgical significance of six anomalies of the biliary duct system. Surg Gynecol Obstet. 1970; 131:655–660. PMID: 4989834.

4. Kubota T, Fujioka T, Honda S, et al. The papilla of Vater emptying into the duodenal bulb. Report of two cases. Jpn J Med. 1988; 27:79–82. PMID: 3367542.

5. Lee SS, Kim MH, Lee SK, et al. Ectopic opening of the common bile duct in the duodenal bulb: clinical implications. Gastrointest Endosc. 2003; 57:679–682. PMID: 12709696.

6. Boyden EA. The problem of the double ductus choledochus (an interpretation of an accessory bile duct found attached to the pars superior of the duodenum). Anat Rec. 1932; 55:71–93.

7. Boyden EA. Congenital variations of the extrahepatic biliary tract: a review. Minn Med. 1944; 27:932–933.

8. Disibeyaz S, Parlak E, Cicek B, et al. Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment. BMC Gastroenterol. 2007; 7:26. PMID: 17610747.

9. Hwang SS, Park SY. Ectopic opening of the common bile duct into the duodenal bulb: a case report. J Korean Soc Radiol. 2009; 61:109–112.

10. Lindner HH, Peña VA, Ruggeri RA. A clinical and anatomical study of anomalous terminations of the common bile duct into the duodenum. Ann Surg. 1976; 184:626–632. PMID: 984933.

11. Lee HJ, Ha HK, Kim MH, et al. ERCP and CT findings of ectopic drainage of the common bile duct into the duodenal bulb. AJR Am J Roentgenol. 1997; 169:517–520. PMID: 9242767.

12. Krstic M, Stimec B, Krstic R, Ugljesic M, Knezevic S, Jovanovic I. EUS diagnosis of ectopic opening of the common bile duct in the duodenal bulb: a case report. World J Gastroenterol. 2005; 11:5068–5071. PMID: 16124069.