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. 2022 Jul;28(4):286-293.
doi: 10.5152/dir.2022.201026.

Ectopic opening of common bile duct into the duodenal bulb: magnetic resonance cholangiopancreatography findings

Ayşe Erden  1 , Diğdem Kuru Öz  1 , İlhan Erden  1
Affiliations

Ectopic opening of common bile duct into the duodenal bulb: magnetic resonance cholangiopancreatography findings

Ayşe Erden et al. Diagn Interv Radiol. 2022 Jul.

Abstract

PURPOSE We aimed to evaluate the spectrum of magnetic resonance cholangiopancreatography (MRCP) findings in patients with ectopic opening of the common bile duct (CBD) into the duodenal bulb and to determine the effectiveness of the MRCP technique in diagnosis. METHODS Morphologic and morphometric MRCP/MRI features in 16 patients and 36 controls were retrospectively analyzed by 2 radiologists. The frequency of MRCP findings was determined. The significance of the difference between the MRCP observations in patients and controls was evaluated statistically and the diagnostic effectiveness of MRCP was investigated. RESULTS Hook-shaped ending of CBD and bulbar deformity were the most frequent morphologic findings seen on MRCP in the ectopic bulbar opening. Mean pylorus-papilla distance and mean CBD length were significantly shorter and the median diameter of CBD was significantly larger than the control group (patients: 28.6 ± 15.3 mm, 33.7 ± 12.8 mm, 8.6 (2-16) mm; controls: 66.7 ± 11.7 mm, 50.3 ± 14.4 mm, 3.2 (1.5-10) mm, P < .001, respectively). Receiver operating curve analysis showed sensitivity and specificity of MRCP in the diagnosis to be 87.5% and 100%, respectively, if any 3 of the 4 signs (hook-shaped ending of CBD, bulbar deformity, large, and short CBD) were present in a patient whose pylorus-papilla distance was <50 mm. CONCLUSION At MRCP, the presence of short and large CBD with a hook-shaped ending in the deformed duodenal bulb may support the diagnosis of ectopic biliary drainage.

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Conflict of interest statement

Conflict of interest disclosure The authors declared no conflicts of interest.

Figures

Figure 1.
Figure 1.
A 46-year-old woman in whom magnetic resonance cholangiopancreatography (MRCP) is requested for a suspected common bile duct (CBD) stone. Coronal heavily T2-weighted thick-slab MRCP shows the measurement of pyloric-papilla distance is normal in this case. The total distance is 7.6 cm. Arrow indicates pylorus (P) and asterisk (*) indicates papilla. B, duodenal bulb; S, stomach.
Figure 2.
Figure 2.
A 56-year-old man had undergone gastrojejunostomy but had persistent dyspeptic complaints. Since the CBD and pancreatic duct are large in ultrasonography, MRCP was requested with suspicion of pancreatic head cancer. Coronal heavily T2-weighted thick-slab MRCP shows dilated CBD (12 mm) which angulated superolaterally. Arrow and asterisk (*) indicate pylorus (P) and papilla, respectively. Pylorus-papilla distance is 4.25 cm in this case with an ectopic opening. B, duodenal bulb; S, stomach.
Figure 3.
Figure 3.
A 72-year-old man with episodic abdominal pain and fever. Coronal heavily T2-weighted thick-slab MRCP shows dilated CBD (asterisk) which opens into duodenal bulb. Note filling defects (small arrows) in CBD due to stones and air. Intrahepatic biliary dilatation, pneumobilia, and sludge/ stones in gallbladder and CBD are associated with the ectopic opening anomaly. Arrow indicates main pancreatic duct (MPD). The patient had also gastrojejunostomy (not shown) due to apical stricture. B, duodenal bulb; GB, gall bladder.
Figure 4.
Figure 4.
A 48-year-old man with abdominal pain, pruritis, and jaundice. Coronal heavily T2-weighted thick-slab MRCP shows dilatation in intrahepatic bile ducts. Note turning of the distal end of the CBD to the right toward the bulb of the duodenum. Proximal extrahepatic bile duct is not visualized because of pneumobilia (asterisk). Note narrowing of apical portion of the duodenal bulb (arrow) that causes bulbar deformity. B, duodenal bulb; S, stomach.
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