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EUS diagnosis of ectopic opening of the common bile duct in the duodenal bulb: A case report

World Journal of Gastroenterology 2005年第32期11卷 5068-5071页

作者： Miodrag Krstic Bojan Stimec Radmilo Krstic milenko ugljesic Srbislav Knezevic Ivan Jovanovic Clinical Center of SerbiaBelgrade Serbia and Montenegro Institute for AnatomySchool of Medicine BelgradeSerbia and Montenegro

Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and *** far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.

关键词： Ectopic opening Common bile duct Congenital anomaly Endoscopic ultrasound

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Double common bile duct: A case report

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World Journal of Gastroenterology 2007年第27期13卷 3770-3772页

作者： Srdjan P Djuranovic milenko B ugljesic Nenad S Mijalkovic Viktorija A Korneti Nada V Kovacevic Tamara M Alempijevic Slaven V Radulovic Dragan V Tomic Milan M Spuran Clinic for Gastroenterology and Hepatology Clinical Center of Serbia Belgrade Serbia 1st Surgical Clinic Clinical Center of Serbia Belgrade Serbia

Double common bile duct （DCBD） is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct （ACBD） opens in different parts of upper gastrointestinal tract （stomach, duodenum, ductus pancreaticus or septum）. This anomaly is of great importance since it is often associated with biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction （APBJ） and upper gastrointestinal tract malignancies. We recently recognized a rare case of DCBD associated with APB3 with lithiasis in better developed common bile duct. The opening site of ACBD was in the pancreatic duct. The anomaly was suspected by transabdominal ultrasonography and finally confirmed by endoscopic retrograde cholangiopancreatography （ERCP） followed by endoscopic sphincterotomy and stone extraction. According to the literature, the existence of DCBD with the opening of ACBD in the pancreatic duct is most frequently associated with APB3 and gallbladder carcinoma. In case of DCBD, the opening site of ACBD is of greatest clinical importance because of its close implications with concomitant pathology. The adequate diagnosis of this rare anomaly is significant since the operative complications may occur in cases with DCBD which is not recognized prior to surgical treatment.

关键词： Double common bile duct Accessory common bile duct Anomalous pancreaticobiliary junction

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