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. 2015 May;48(3):260-4.
doi: 10.5946/ce.2015.48.3.260. Epub 2015 May 29.

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

Jae Min Lee  1 , Hong Jun Kim  2 , Chang Yoon Ha  2 , Hyun Ju Min  2 , Hyunjin Kim  2 , Tae Hyo Kim  2 , Woon Tae Jung  2 , Ok Jae Lee  2
Affiliations

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

Jae Min Lee et al. Clin Endosc. 2015 May.

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.

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

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Conflict of interest statement

Conflicts of Interest: The authors have no financial conflicts of interest.

Figures

Fig. 1
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).
Fig. 2
Fig. 2. Endoscopic papillary balloon dilation was performed with a balloon catheter (A) and common bile duct stones were removed using a basket (B).
Fig. 3
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).
Fig. 4
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).
Fig. 5
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).
See this image and copyright information in PMC

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