Ectopic Opening of the Common Bile Duct Accompanied by Choledochocele and Pancreas Divisum

Duodenal stenosis associated with an ectopic opening of the common bile duct into the duodenal bulb: a case report

Background

Ectopic opening of the common bile duct is a rare congenital biliary anomaly. Herein, we present a case of duodenal stenosis with ectopic opening of the common bile duct into the duodenal bulb.

Case presentation

A 54-year-old man was referred with fever, nausea, and vomiting. He had experienced epigastric pain several times over the past 30 years. Endoscopy showed a post-bulbar ulcer, a submucosal tumor of the duodenum, and a small opening with bile secretion. Contrast duodenography revealed duodenal stenosis and bile reflux with a common bile duct deformity. Pancreatoduodenectomy was performed because of the clinical suspicion of a biliary neoplasm or groove pancreatitis. The resected specimen showed an ectopic opening of the common bile duct into the duodenal bulb and no tumor.

Conclusions

Ectopic opening of the common bile duct into the duodenal bulb is complicated by a duodenal ulcer, deformity, and stenosis mimicking groove pancreatitis or pancreatic tumors. Although rare, we should be aware of this anomaly for an accurate diagnosis.

Ectopic opening of the common bile duct into the duodenal bulb with recurrent choledocholithiasis: A case report

BACKGROUND

Ectopic opening of the common bile duct is a condition with low incidence. Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis. Patients with atypical symptoms and imaging findings are easily misdiagnosed; moreover, it is difficult to retrieve stones by endoscopic retrograde cholangiopancreatography, and common bile duct stones are prone to postsurgical recurrence.

CASE SUMMARY

A 45-year-old male patient presented with “intermittent upper abdominal pain and elevated liver enzymes for 1 wk”. Transabdominal ultrasound indicated dilation of the common bile duct and the presence of stones. Magnetic resonance imaging showed that the common bile duct was dilated with stones and that its opening was ectopic. Endoscopic retrograde cholangiopancreatography revealed an abnormal opening of the common bile duct into the duodenal bulb and the presence of common bile duct stones. Laparoscopic extrahepatic choledochectomy and hepatoenteric anastomosis were performed. After surgery, the patient recovered well and was discharged. The patient has been followed up for 2 years since the operation. He has not experienced stone recurrence, and his liver function and quality of life are good.

CONCLUSION

Improved understanding of ectopic opening of the common bile duct is needed for clinicians to provide patients with appropriate treatment.

Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: Diagnosis and Therapeutic Management and Considerations for Timing of Surgery and Duration of Follow-up After Initial Endoscopic Retrograde Cholangiopancreatography

INTRODUCTION

Ectopic opening of the common bile duct (EO-CBD) is a rare pathology, and its management is important. To date, only a few studies have been conducted for EO-CBD due to its low incidence.

MATERIALS AND METHODS

A retrospective review was conducted on 54 patients with available prospective data. Among them, 30 patients (group 1) underwent choledochoduodenostomy for reasons other than anomalous opening, and 24 patients (group 2) had an EO-CBD.

RESULTS

Endoscopic retrograde cholangiopancreatography (ERCP) was performed for 24 patients with duodenal deformity and apical stenosis. EO-CBD was detected in 2.72% of all patients who underwent ERCP (24/880 ERCPs). The occurrence of hyperbilirubinemia (total bilirubin >1.2 mg/dL) was not significantly different between groups: 3.83±4.57 mg/dL for group 1 and 2.26±2.17 mg/dL for group 2.

CONCLUSIONS

Failed ERCP, giant stones, and recurrent episodes (>2) of cholangitis requiring ERCP constitute indications for surgical treatment in cases of EO-CBD into the duodenum.