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Nuamah NM, Ibis C, Gok AFK, Ekiz F, Acunas B. Duplicated common bile duct: a recipe for biliary injury. Report of a new variant. J Surg Case Rep 2017; 2017:rjx021. [PMID: 28458830 PMCID: PMC5400428 DOI: 10.1093/jscr/rjx021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/26/2017] [Indexed: 12/23/2022] Open
Abstract
Duplicated common bile duct, often associated with conditions like lithiasis, biliary cysts and pancreatobiliary maljunction, could result in highly morbid and potentially fatal biliary injuries. Precise preoperative diagnosis and classification still remain a challenge. A female patient undergoing emergency laparoscopic cholecystectomy for acute calculous cholecystitis sustained iatrogenic bile duct injury. A drainage tube was placed into the injured duct for post-operative conservative management. Post-operative tube cholangiogram revealed a double common bile duct with cystic duct opening distally. This was identified as a new variant not previously reported or classified. However rare, duplicated common bile duct could result in serious iatrogenic bile duct injury if unidentified during surgery. Knowledge of its existence is essential to avoid such injuries as preoperative diagnosis still remains a challenge. A thorough clinical and morphological study of previously reported variants is needed for a comprehensive classification to encompass newly discovered variants.
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Affiliation(s)
- Nabil M Nuamah
- Department of Surgery, 37 Military Hospital, Accra, Ghana
| | - Cem Ibis
- Department of Surgery, Hepatopancreatobiliary and Liver Transplant Unit Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Ali F K Gok
- Department of Surgery Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Feza Ekiz
- Department of Surgery Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
| | - Bulent Acunas
- Department of Radiology Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey
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Gonzalez RS, Bagci P, Basturk O, Reid MD, Balci S, Knight JH, Kong SY, Memis B, Jang KT, Ohike N, Tajiri T, Bandyopadhyay S, Krasinskas AM, Kim GE, Cheng JD, Adsay NV. Intrapancreatic distal common bile duct carcinoma: Analysis, staging considerations, and comparison with pancreatic ductal and ampullary adenocarcinomas. Mod Pathol 2016; 29:1358-1369. [PMID: 27469329 PMCID: PMC5598556 DOI: 10.1038/modpathol.2016.125] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 01/04/2023]
Abstract
Distal common bile duct carcinoma is a poorly characterized entity for reasons such as variable terminology and difficulty in determining site of origin of intrapancreatic lesions. We compared clinicopathologic features of pancreatobiliary-type adenocarcinomas within the pancreas, but arising from the distal common bile duct, with those of pancreatic and ampullary origin. Upon careful review of 1017 pancreatoduodenectomy specimens with primary adenocarcinoma, 52 (5%) qualified as intrapancreatic distal common bile duct carcinoma. Five associated with an intraductal papillary neoplasm were excluded; the remaining 47 were compared to 109 pancreatic ductal adenocarcinomas and 133 ampullary carcinomas. Distal common bile duct carcinoma patients had a younger median age (58 years) than pancreatic ductal adenocarcinoma patients (65 years) and ampullary carcinoma patients (68 years). Distal common bile duct carcinoma was intermediate between pancreatic ductal adenocarcinoma and ampullary carcinoma with regard to tumor size and rates of node metastases and margin positivity. Median survival was better than for pancreatic ductal adenocarcinoma (P=0.0010) but worse than for ampullary carcinoma (P=0.0006). Distal common bile duct carcinoma often formed an even band around the common bile duct and commonly showed intraglandular neutrophil-rich debris and a small tubular pattern. Poor prognostic indicators included node metastasis (P=0.0010), lymphovascular invasion (P=0.0299), and margin positivity (P=0.0069). Categorizing the tumors based on size also had prognostic relevance (P=0.0096), unlike categorization based on anatomic structures invaded. Primary distal common bile duct carcinoma is seen in younger patients than pancreatic ductal adenocarcinoma or ampullary carcinoma. Its prognosis is significantly better than pancreatic ductal adenocarcinoma and worse than ampullary carcinoma, at least partly because of differences in clinical presentation. Use of size-based criteria for staging appears to improve its prognostic relevance. Invasive pancreatobiliary-type distal common bile duct carcinomas are uncommon in the West and have substantial clinicopathologic differences from carcinomas arising from the pancreas and ampulla.
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Affiliation(s)
- Raul S. Gonzalez
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA
| | - Pelin Bagci
- Department of Pathology, Marmara University, Istanbul, Turkey
| | - Olca Basturk
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Serdar Balci
- Department of Pathology, Emory University, Atlanta, GA, USA
| | | | - So Yeon Kong
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Bahar Memis
- Department of Pathology, Emory University, Atlanta, GA, USA
| | - Kee-Taek Jang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Nobuyuki Ohike
- Department of Pathology, Showa University School of Medicine, Tokyo, Japan
| | - Takuma Tajiri
- Department of Pathology, Tokai University Hachiouji Hospital, Tokyo, Japan
| | | | | | - Grace E. Kim
- Department of Pathology, University of California, San Francisco, San Francisco, CA, USA
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Two Cases of Type Va Extrahepatic Bile Duct Duplication With Distal Klatskin Tumor Surgically Treated with Whipple Procedure and Hepaticojejunostomy. ACG Case Rep J 2015; 3:49-52. [PMID: 26504879 PMCID: PMC4612759 DOI: 10.14309/crj.2015.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 08/25/2015] [Indexed: 11/17/2022] Open
Abstract
We describe the diagnostic and therapeutic challenges of a type Va extrahepatic bile duct duplication coexistent with distally located hilar cholangiocarcinoma (Klatskin tumor). We present 2 cases that were diagnosed preoperatively and treated with a modified surgical technique of a combined pylorus-preserving Whipple procedure and hepaticojejunostomy.
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