Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Duplication of the extrahepatic bile duct

Duplication of the extrahepatic bile duct Rationale: Duplication of the extrahepatic bile duct is an extremely rare congenital anomaly of the biliary system. Patient concerns: A 44-year-old woman presented with a history of continuous upper abdominal pain and vomiting. Diagnoses: Magnetic resonance cholangiopancreatography (MRCP) disclosed diffuse dilatation of the intrahepatic and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) showed the presence of two extrahepatic bile ducts with calculus at the distal end of the CBD. Interventions: Laparoscopic cholecystectomy (LC) was performed after an ERCP. Choledochoscopy, performed during the operation, showed duplicated common bile duct and the cystic duct was seen opening at the right side of the extrahepatic duct. Outcomes: The patient was doing well after 6 months of follow-up. Lessons: We reported a case of a double common duct with choledocholithiasis and gallstone. This rare anomaly may lead to cholangitis, common bile duct injury during surgery, malignancy occurrence, and should be treated with extreme care. Abbreviations: CBD = common bile duct, CT = computed tomography, DCBD = double common bile duct, ERCP = endoscopic retrograde cholangiopancreatography, LC = laparoscopic cholecystectomy, MRCP = magnetic resonance cholangiopancreatog- raphy. Keywords: case report, double common bile duct, duplication of the extrahepatic bile duct, duplication of the extrahepatic bile duct 1. Introduction 2. Case report Duplication of the extrahepatic bile is an extremely rare A 44-year-old Chinese woman was admitted to a local hospital congenital anomaly of the biliary system, which is characterized April 2017 due to persistent upper abdominal pain and vomiting by the presence of a septum within the common bile duct or an for 12 days. The ultrasonography of the abdomen performed at [1] accessory common bile duct. The first double common bile- the local hospital revealed a swollen gallbladder with the [2] duct (DBCD) case was reported by Vesalius in 1543. Before the presence of gallstone and cholecystitis. The episodes of pain were year 2007, there were 4 identified types of such anomaly. In 2007, not relieved by antibiotic treatment with cefuroxime. The patient Choi et al. found a new type of DBCD and classified it as type then came to Sir Run Run Shaw Hospital for a second opinion [3] V. Since then, only 6 type V CBCD have been reported. In this and further treatment. At the time of admission, the patient’s case report, we present a recently recognized a rare case of type physical examination revealed severe tenderness in the upper Vb duplicated common bile duct with choledocholithiasis and right quadrant of the abdomen with positive Murphy sign cholelithiasis. without rebound tenderness or muscle tension. The patient’s liver biochemistry indicated a cholesteric profile, including an alkaline phosphatase of 225U/L (normal U/L), g-glutamyl transferase value of 371U/L (normal U/L), a total bilirubin of 80.5U/L Editor: N/A. (normal U/L), and a direct bilirubin of 64.0U/L (normal U/L). We have obtained informed consent from the patient. The results of the liver function test were evaluated, including an Our study was not based on a previous communication to a society or meeting. alanine aminotransferase of 164U/L and an aspartate amino- The authors report no conflicts of interest. transferase of 233U/L. Serum amylase and lipase indicated an acute pancreatitis (serum amylase 2564U/L; serum lipase 4495 Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, The School of Medicine, Zhejiang University, Hangzhou, U/L). Enhanced computed tomography (CT) examination China. performed at Sir Run Run Shaw Hospital revealed diffuse Correspondence: Hui Lin, Department of General Surgery, Sir Run Run Shaw dilatation of the intrahepatic and extrahepatic bile ducts, with Hospital, Zhejiang University School of Medicine, 3 East Qingchun Rd, Hangzhou suspected common bile duct obstruction and gallstones. 310016, China (e-mail: 369369@zju.edu.cn). Magnetic resonance cholangiopancreatography (MRCP) also Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. disclosed diffuse dilatation of the intrahepatic and extrahepatic This is an open access article distributed under the Creative Commons bile ducts, but no obvious filling-defect was found in the CBD Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with lumen (Fig. 1A). The levels of serum amylase and lipase decreased credit to the author. rapidly after conservative treatment, which included enough Medicine (2018) 97:8(e9953) fluid support and antibiotic. Endoscopic retrograde cholangio- Received: 22 December 2017 / Accepted: 30 January 2018 pancreatography (ERCP) was subsequently performed and demonstrated the presence of 2 extrahepatic bile ducts with http://dx.doi.org/10.1097/MD.0000000000009953 1 Fan et al. Medicine (2018) 97:8 Medicine after this patient recovered from ERCP. Choledochoscopy during the LC also showed common bile duct duplication, and the cystic duct was seen draining into the right-sided extrahepatic duct (Fig. 1C). This 44-year-old female patient was discharged 2 days after LC. Pathological examination of the resected gallbladder and duct revealed a benign gallbladder with chronic cholecystitis. The patient was doing well after 6 months of follow-up. 3. Discussion This case presents an extremely rare congenital anomaly of the adult human biliary system. Duplicated bile ducts are quite common in reptiles, birds, and fish; but in humans, they are very [4] rare. The mechanism of this anomaly is believed to be related to the disruption of early embryogenesis development and preser- [3] vation of an extrahepatic accessory duct. The real incidence rate of this anomaly might never be known because many individuals with this anomaly are asymptomatic throughout their whole lives, making it impossible to even suspect the presence of the anomaly. Goor and Ebert first proposed the classification of DCBD [1] based on the anatomical appearance. The most widely used [3] classification then, was modified by Choi et al. in 2007. According to the Choi’s classification, there are 5 types of DCBD (Fig. 2). Different from the western and Japanese population, the proportion of type I DCBD is higher in the Chinese population than any other types (western vs Japanese vs Chinese 3.6% vs [2,5,6] 8.5% vs 58.3%). Our case was classified as type Vb common bile duct. To date, the current patient was the first type V case reported in the Chinese population and the second type Vb case in the world. The type V of double common bile duct is the rarest type of CBD. Only 6 type V double CBD cases had been reported so far. Five of [3,7–10] them were of type Va, and the remaining one was of type [9] Vb (Table 1). All the 7 patients, including our patient, were female and suffered from abdominal pain. Four cases were diagnosed as common bile duct stone, and the bile stone was removed by ERCP. The case reported by Choi et al. was the only case accompanied with malignant tumor. Despite it being a rarely encountered condition, it is necessary to fully understand this anomaly. Hoepfner et al. reported a case of common bile duct injury during surgery because of the existence of a duplicated CBD, which was not clearly identified [11] during the first operation at a local hospital. They performed a second operation at the University of Alabama School of Medicine Hospital to anastomose the right and left hepatic duct stumps with jejunum. Therefore, recognizing this malformation preoperatively can help avoid potential common bile duct injury intraoperatively. MRCP and ERCP are recommended when a patient is suspected with bile duct anomaly. Since ERCP is an invasive technique and might lead to potential serious compli- Figure 1. Magnetic resonance cholangiopancreatography showed common [3,5,9,12] cations, MRCP is preferred prior to ERCP. For type I bile duct (A); double common bile duct was observed during the ERCP (B); cases, it is harder to be identified. Only 4.2% type I cases can be diagram of the DCBD based on the intraoperative choledochoscopy (C). DCBD [5] = double common bile duct, ERCP = endoscopic retrograde cholangiopan- diagnosed preoperatively. It requires surgeons to carefully creatography. distinguish the anatomy and perform the intraoperative cholangiography if necessary to prevent CBD injury. Another serious issue is that duplicated common bile duct is probably associated with malignant tumor. In the review calculus at the distal end of the CBD. On ERCP, it was observed reported by Yamashita et al., 12, 47 enrolled patients were also that the extrahepatic bile duct was separated into 2 ducts directly diagnosed with different kinds of cancers including pancreatic after the confluence of left and right hepatic ducts, and rejoined as cancer, gastric cancer, gallbladder cancer, and ampullary a single duct and opened into the duodenum at the normal site [6] cancer. This phenomenon may partly due to the continuous (Fig. 1B). Laparoscopic cholecystectomy (LC) was performed 2 Fan et al. Medicine (2018) 97:8 www.md-journal.com Figure 2. Modified double common bile duct classification. Type I, a septum within the CBD lumen; Type II, the distal bile duct bifurcates and each channel independently drains into the different sites (stomach, pancreas, and duodenum); Type III, duplicated extrahepatic bile ducts with (type IIIa) or without (type IIIb) intrahepatic communicating duct; Type IV, duplicated extrahepatic bile ducts with extrahepatic communicating channel or both intrahepatic and extrahepatic communicating channels; Type V, duplicated extrahepatic bile ducts join as a single duct and drain into the duodenum. Table 1 The characteristics of Type V cases in previous literatures. Bile CBD duct No Author Year Country Age Sex Symptoms stone Type Treatment injury Journal 1 E. Choi 2007 Japan 72 Female Right upper quadrant No Va ERCP No The British Journal of pain, jaundice and Radiology pruritus 2 Sang Won Kim 2008 Korea 81 Female Chills and fever, Yes Vb surgery No Korean journal of radiology jaundice 3 Vishal Gupta 2012 India 55 Female Recurrent upper Yes Va surgery No Congenital Anomalies abdominal pain 4 Ankur Arora 2015 India 52 Female Jaundice, right upper Yes Va NM No The Saudi Journal of quadrant abdominal Gastroenterology pain 5 Jun Liong Chin 2017 Ireland 43 Female Severe epigastric No Va ERCP No Gastrointestinal Endoscopy discomfort, chills and rigors 6 Rodríguez-Luna 2017 Mexico 27 Female Intermittent colic pain in Yes Va Laparoscopic No Journal of Gastrointestinal right upper quadrant cholecystectomy Surgery ERCP = endoscopic retrograde cholangiopancreatography, NM= no mention. regurgitation of gastric or pancreatic juice into extrahepatic bile the extrahepatic bile duct is extremely rare, DCBD often presents [3] duct. In addition, no Type I case presented with cancer was with choledocholithiasis, cholangitis, gallstone, and malignant found in previous literatures; the reason for this phenomenon tumor, and needs close monitoring in view of providing further might be due to that type I DCMD patients have no anomalous treatment. The correct identification of DCBD would allow safer pancreaticobiliary maljunction. For type I DCBD, simple surgical interventions. resection of the septum is recommended instead of resection of the whole bile duct because of the low incidence of malignancy. References On the other hand, for types II, III, and IV DCBD, patients should undergo operation to resect accessory duct, which opens into the [1] Goor DA, Ebert PA. Anomalies of the biliary tree. Report of a repair of an stomach or pancreas and strict follow-up to monitor the possible accessory bile duct and review of the literature. Arch Surg [13] 1972;104:302–9. malignancy occurrence. However, the strategy for type V [2] Teilum D. Double common bile duct. Case report and review. Endoscopy DCBD is still unclear. We think strict monitoring would be a 1986;18:159–61. proper strategy. [3] Choi E, Byun JH, Park BJ, et al. Duplication of the extrahepatic bile duct In conclusion, one of the rarest bile duct anomaly cases was with anomalous union of the pancreaticobiliary ductal system revealed by MR cholangiopancreatography. Br J Radiol 2007;80:e150–4. reported in this paper. Although the incidence of duplication of 3 Fan et al. Medicine (2018) 97:8 Medicine [4] Arora A, Sureka B, Kasana V, et al. Common bile duct [9] Kim SW, Park DH, Shin HC, et al. Duplication of the extrahepatic bile duplication: the more the murkier. Saudi J Gastroenterol duct in association with choledocholithiasis as depicted by MDCT. 2015;21:51–4. Korean J Radiol 2008;9:550–4. [5] Chen G, Wang H, Zhang L, et al. Double common bile duct with [10] Rodriguez-Luna MR, Guarneros-Zarate JE, Noriega-Usi VM, et al. A choledochal cyst and cholelithiasis: report of a case. Surg Today Rare but Important Anatomical Variation to Know. J Gastrointest Surg 2014;44:778–82. 2017;21:2124–5. [6] Yamashita K, Oka Y, Urakami A, et al. Double common bile duct: a [11] Hoepfner L, Sweeney MK, White JA. Duplicated extrahepatic bile duct case report and a review of the Japanese literature. Surgery 2002; identified following cholecystectomy injury. J Surg Case Rep 2016;2016: 131:676–81. pii: rjw064. doi: 10.1093/jscr/rjw064. [7] Chin JL, Sengupta S, Morrin MM, et al. Common bile duct [12] Arase Y, Deguchi R, Tsukune Y, et al. Double common bile duct with duplication: double bile ducts, double trouble. Gastrointest Endosc ectopic drainage into the stomach found in asymptomatic. Tokai J Exp 2017;85:855–6. Clin Med 2016;41:108–11. [8] Gupta V, Chandra A. Duplication of the extrahepatic bile duct. Congenit [13] Djuranovic SP, Ugljesic MB, Mijalkovic NS, et al. Double common bile Anom (Kyoto) 2012;52:176–8. duct: a case report. World J Gastroenterol 2007;13:3770–2. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Medicine Wolters Kluwer Health

Duplication of the extrahepatic bile duct

Download PDF
4 pages

Loading next page...
1
 
/lp/wolters_kluwer/duplication-of-the-extrahepatic-bile-duct-VV0wu40ihV

References (13)

Publisher
Wolters Kluwer Health
Copyright
Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc.
ISSN
0025-7974
eISSN
1536-5964
DOI
10.1097/MD.0000000000009953
pmid
29465584
Publisher site
See Article on Publisher Site

Abstract

Rationale: Duplication of the extrahepatic bile duct is an extremely rare congenital anomaly of the biliary system. Patient concerns: A 44-year-old woman presented with a history of continuous upper abdominal pain and vomiting. Diagnoses: Magnetic resonance cholangiopancreatography (MRCP) disclosed diffuse dilatation of the intrahepatic and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) showed the presence of two extrahepatic bile ducts with calculus at the distal end of the CBD. Interventions: Laparoscopic cholecystectomy (LC) was performed after an ERCP. Choledochoscopy, performed during the operation, showed duplicated common bile duct and the cystic duct was seen opening at the right side of the extrahepatic duct. Outcomes: The patient was doing well after 6 months of follow-up. Lessons: We reported a case of a double common duct with choledocholithiasis and gallstone. This rare anomaly may lead to cholangitis, common bile duct injury during surgery, malignancy occurrence, and should be treated with extreme care. Abbreviations: CBD = common bile duct, CT = computed tomography, DCBD = double common bile duct, ERCP = endoscopic retrograde cholangiopancreatography, LC = laparoscopic cholecystectomy, MRCP = magnetic resonance cholangiopancreatog- raphy. Keywords: case report, double common bile duct, duplication of the extrahepatic bile duct, duplication of the extrahepatic bile duct 1. Introduction 2. Case report Duplication of the extrahepatic bile is an extremely rare A 44-year-old Chinese woman was admitted to a local hospital congenital anomaly of the biliary system, which is characterized April 2017 due to persistent upper abdominal pain and vomiting by the presence of a septum within the common bile duct or an for 12 days. The ultrasonography of the abdomen performed at [1] accessory common bile duct. The first double common bile- the local hospital revealed a swollen gallbladder with the [2] duct (DBCD) case was reported by Vesalius in 1543. Before the presence of gallstone and cholecystitis. The episodes of pain were year 2007, there were 4 identified types of such anomaly. In 2007, not relieved by antibiotic treatment with cefuroxime. The patient Choi et al. found a new type of DBCD and classified it as type then came to Sir Run Run Shaw Hospital for a second opinion [3] V. Since then, only 6 type V CBCD have been reported. In this and further treatment. At the time of admission, the patient’s case report, we present a recently recognized a rare case of type physical examination revealed severe tenderness in the upper Vb duplicated common bile duct with choledocholithiasis and right quadrant of the abdomen with positive Murphy sign cholelithiasis. without rebound tenderness or muscle tension. The patient’s liver biochemistry indicated a cholesteric profile, including an alkaline phosphatase of 225U/L (normal U/L), g-glutamyl transferase value of 371U/L (normal U/L), a total bilirubin of 80.5U/L Editor: N/A. (normal U/L), and a direct bilirubin of 64.0U/L (normal U/L). We have obtained informed consent from the patient. The results of the liver function test were evaluated, including an Our study was not based on a previous communication to a society or meeting. alanine aminotransferase of 164U/L and an aspartate amino- The authors report no conflicts of interest. transferase of 233U/L. Serum amylase and lipase indicated an acute pancreatitis (serum amylase 2564U/L; serum lipase 4495 Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, The School of Medicine, Zhejiang University, Hangzhou, U/L). Enhanced computed tomography (CT) examination China. performed at Sir Run Run Shaw Hospital revealed diffuse Correspondence: Hui Lin, Department of General Surgery, Sir Run Run Shaw dilatation of the intrahepatic and extrahepatic bile ducts, with Hospital, Zhejiang University School of Medicine, 3 East Qingchun Rd, Hangzhou suspected common bile duct obstruction and gallstones. 310016, China (e-mail: 369369@zju.edu.cn). Magnetic resonance cholangiopancreatography (MRCP) also Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. disclosed diffuse dilatation of the intrahepatic and extrahepatic This is an open access article distributed under the Creative Commons bile ducts, but no obvious filling-defect was found in the CBD Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with lumen (Fig. 1A). The levels of serum amylase and lipase decreased credit to the author. rapidly after conservative treatment, which included enough Medicine (2018) 97:8(e9953) fluid support and antibiotic. Endoscopic retrograde cholangio- Received: 22 December 2017 / Accepted: 30 January 2018 pancreatography (ERCP) was subsequently performed and demonstrated the presence of 2 extrahepatic bile ducts with http://dx.doi.org/10.1097/MD.0000000000009953 1 Fan et al. Medicine (2018) 97:8 Medicine after this patient recovered from ERCP. Choledochoscopy during the LC also showed common bile duct duplication, and the cystic duct was seen draining into the right-sided extrahepatic duct (Fig. 1C). This 44-year-old female patient was discharged 2 days after LC. Pathological examination of the resected gallbladder and duct revealed a benign gallbladder with chronic cholecystitis. The patient was doing well after 6 months of follow-up. 3. Discussion This case presents an extremely rare congenital anomaly of the adult human biliary system. Duplicated bile ducts are quite common in reptiles, birds, and fish; but in humans, they are very [4] rare. The mechanism of this anomaly is believed to be related to the disruption of early embryogenesis development and preser- [3] vation of an extrahepatic accessory duct. The real incidence rate of this anomaly might never be known because many individuals with this anomaly are asymptomatic throughout their whole lives, making it impossible to even suspect the presence of the anomaly. Goor and Ebert first proposed the classification of DCBD [1] based on the anatomical appearance. The most widely used [3] classification then, was modified by Choi et al. in 2007. According to the Choi’s classification, there are 5 types of DCBD (Fig. 2). Different from the western and Japanese population, the proportion of type I DCBD is higher in the Chinese population than any other types (western vs Japanese vs Chinese 3.6% vs [2,5,6] 8.5% vs 58.3%). Our case was classified as type Vb common bile duct. To date, the current patient was the first type V case reported in the Chinese population and the second type Vb case in the world. The type V of double common bile duct is the rarest type of CBD. Only 6 type V double CBD cases had been reported so far. Five of [3,7–10] them were of type Va, and the remaining one was of type [9] Vb (Table 1). All the 7 patients, including our patient, were female and suffered from abdominal pain. Four cases were diagnosed as common bile duct stone, and the bile stone was removed by ERCP. The case reported by Choi et al. was the only case accompanied with malignant tumor. Despite it being a rarely encountered condition, it is necessary to fully understand this anomaly. Hoepfner et al. reported a case of common bile duct injury during surgery because of the existence of a duplicated CBD, which was not clearly identified [11] during the first operation at a local hospital. They performed a second operation at the University of Alabama School of Medicine Hospital to anastomose the right and left hepatic duct stumps with jejunum. Therefore, recognizing this malformation preoperatively can help avoid potential common bile duct injury intraoperatively. MRCP and ERCP are recommended when a patient is suspected with bile duct anomaly. Since ERCP is an invasive technique and might lead to potential serious compli- Figure 1. Magnetic resonance cholangiopancreatography showed common [3,5,9,12] cations, MRCP is preferred prior to ERCP. For type I bile duct (A); double common bile duct was observed during the ERCP (B); cases, it is harder to be identified. Only 4.2% type I cases can be diagram of the DCBD based on the intraoperative choledochoscopy (C). DCBD [5] = double common bile duct, ERCP = endoscopic retrograde cholangiopan- diagnosed preoperatively. It requires surgeons to carefully creatography. distinguish the anatomy and perform the intraoperative cholangiography if necessary to prevent CBD injury. Another serious issue is that duplicated common bile duct is probably associated with malignant tumor. In the review calculus at the distal end of the CBD. On ERCP, it was observed reported by Yamashita et al., 12, 47 enrolled patients were also that the extrahepatic bile duct was separated into 2 ducts directly diagnosed with different kinds of cancers including pancreatic after the confluence of left and right hepatic ducts, and rejoined as cancer, gastric cancer, gallbladder cancer, and ampullary a single duct and opened into the duodenum at the normal site [6] cancer. This phenomenon may partly due to the continuous (Fig. 1B). Laparoscopic cholecystectomy (LC) was performed 2 Fan et al. Medicine (2018) 97:8 www.md-journal.com Figure 2. Modified double common bile duct classification. Type I, a septum within the CBD lumen; Type II, the distal bile duct bifurcates and each channel independently drains into the different sites (stomach, pancreas, and duodenum); Type III, duplicated extrahepatic bile ducts with (type IIIa) or without (type IIIb) intrahepatic communicating duct; Type IV, duplicated extrahepatic bile ducts with extrahepatic communicating channel or both intrahepatic and extrahepatic communicating channels; Type V, duplicated extrahepatic bile ducts join as a single duct and drain into the duodenum. Table 1 The characteristics of Type V cases in previous literatures. Bile CBD duct No Author Year Country Age Sex Symptoms stone Type Treatment injury Journal 1 E. Choi 2007 Japan 72 Female Right upper quadrant No Va ERCP No The British Journal of pain, jaundice and Radiology pruritus 2 Sang Won Kim 2008 Korea 81 Female Chills and fever, Yes Vb surgery No Korean journal of radiology jaundice 3 Vishal Gupta 2012 India 55 Female Recurrent upper Yes Va surgery No Congenital Anomalies abdominal pain 4 Ankur Arora 2015 India 52 Female Jaundice, right upper Yes Va NM No The Saudi Journal of quadrant abdominal Gastroenterology pain 5 Jun Liong Chin 2017 Ireland 43 Female Severe epigastric No Va ERCP No Gastrointestinal Endoscopy discomfort, chills and rigors 6 Rodríguez-Luna 2017 Mexico 27 Female Intermittent colic pain in Yes Va Laparoscopic No Journal of Gastrointestinal right upper quadrant cholecystectomy Surgery ERCP = endoscopic retrograde cholangiopancreatography, NM= no mention. regurgitation of gastric or pancreatic juice into extrahepatic bile the extrahepatic bile duct is extremely rare, DCBD often presents [3] duct. In addition, no Type I case presented with cancer was with choledocholithiasis, cholangitis, gallstone, and malignant found in previous literatures; the reason for this phenomenon tumor, and needs close monitoring in view of providing further might be due to that type I DCMD patients have no anomalous treatment. The correct identification of DCBD would allow safer pancreaticobiliary maljunction. For type I DCBD, simple surgical interventions. resection of the septum is recommended instead of resection of the whole bile duct because of the low incidence of malignancy. References On the other hand, for types II, III, and IV DCBD, patients should undergo operation to resect accessory duct, which opens into the [1] Goor DA, Ebert PA. Anomalies of the biliary tree. Report of a repair of an stomach or pancreas and strict follow-up to monitor the possible accessory bile duct and review of the literature. Arch Surg [13] 1972;104:302–9. malignancy occurrence. However, the strategy for type V [2] Teilum D. Double common bile duct. Case report and review. Endoscopy DCBD is still unclear. We think strict monitoring would be a 1986;18:159–61. proper strategy. [3] Choi E, Byun JH, Park BJ, et al. Duplication of the extrahepatic bile duct In conclusion, one of the rarest bile duct anomaly cases was with anomalous union of the pancreaticobiliary ductal system revealed by MR cholangiopancreatography. Br J Radiol 2007;80:e150–4. reported in this paper. Although the incidence of duplication of 3 Fan et al. Medicine (2018) 97:8 Medicine [4] Arora A, Sureka B, Kasana V, et al. Common bile duct [9] Kim SW, Park DH, Shin HC, et al. Duplication of the extrahepatic bile duplication: the more the murkier. Saudi J Gastroenterol duct in association with choledocholithiasis as depicted by MDCT. 2015;21:51–4. Korean J Radiol 2008;9:550–4. [5] Chen G, Wang H, Zhang L, et al. Double common bile duct with [10] Rodriguez-Luna MR, Guarneros-Zarate JE, Noriega-Usi VM, et al. A choledochal cyst and cholelithiasis: report of a case. Surg Today Rare but Important Anatomical Variation to Know. J Gastrointest Surg 2014;44:778–82. 2017;21:2124–5. [6] Yamashita K, Oka Y, Urakami A, et al. Double common bile duct: a [11] Hoepfner L, Sweeney MK, White JA. Duplicated extrahepatic bile duct case report and a review of the Japanese literature. Surgery 2002; identified following cholecystectomy injury. J Surg Case Rep 2016;2016: 131:676–81. pii: rjw064. doi: 10.1093/jscr/rjw064. [7] Chin JL, Sengupta S, Morrin MM, et al. Common bile duct [12] Arase Y, Deguchi R, Tsukune Y, et al. Double common bile duct with duplication: double bile ducts, double trouble. Gastrointest Endosc ectopic drainage into the stomach found in asymptomatic. Tokai J Exp 2017;85:855–6. Clin Med 2016;41:108–11. [8] Gupta V, Chandra A. Duplication of the extrahepatic bile duct. Congenit [13] Djuranovic SP, Ugljesic MB, Mijalkovic NS, et al. Double common bile Anom (Kyoto) 2012;52:176–8. duct: a case report. World J Gastroenterol 2007;13:3770–2.

Journal

Medicine – Wolters Kluwer Health

Published: Feb 1, 2018

There are no references for this article.