Related Experiment Video
Updated: May 4, 2026
04:02
Laparoscopic Cholecystectomy with Indocyanine Green Fluorescence: Choledochoscopic Stone Extraction and Primary Duct Suture
Published on: November 25, 2025
895
Double-duct sign: do not forget the gallstones
Leendert H Oterdoom1, Stijn J B van Weyenberg, Nanne K H de Boer
1Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam The Netherlands;
Journal of Gastrointestinal and Liver Diseases : JGLD
|December 27, 2013
Summary
The double-duct sign, indicating bile and pancreatic duct dilation, can be caused by pancreatic cancer or gallstones. This case highlights choledocholithiasis as a cause, emphasizing varied diagnostic implications.
Area of Science:
- Gastroenterology
- Diagnostic Imaging
- Oncology
Background:
- The double-duct sign, characterized by simultaneous dilation of the common bile duct and pancreatic duct, is often associated with pancreatic cancer.
- However, other conditions, such as choledocholithiasis (gallstones in the bile duct), can also present with this sign.
Observation:
- A patient presented with right upper quadrant abdominal pain.
- Radiological imaging and endosonography revealed a double-duct sign attributed to choledocholithiasis, with no evidence of a pancreatic head mass.
Findings:
- Literature review indicates that in selected patients with risk factors for pancreatic cancer (e.g., jaundice, pancreatic mass), up to 85% have malignancy.
- In unselected populations, pancreatic malignancy accounts for 58% of double-duct signs found via endoscopic retrograde cholangiopancreatography (ERCP).
- The sensitivity and specificity of the double-duct sign for pancreatic cancer detection via ERCP range from 50-76% and 63-80%, respectively.
Implications:
- This case underscores that the double-duct sign is not exclusively indicative of pancreatic cancer and can be caused by benign conditions like choledocholithiasis.
- Accurate diagnosis is crucial for appropriate patient management, as demonstrated by the patient's successful ERCP for stone extraction and subsequent referral for cholecystectomy.
- Further research may refine the diagnostic utility of the double-duct sign in specific clinical contexts.
Related Concept Videos
01:20Cholecystitis
29
Cholecystitis is inflammation of the gallbladder, most commonly caused by obstruction of the cystic duct. This blockage prevents bile from draining, leading to gallbladder distension, inflammation, and potentially serious complications. This condition may present acutely or chronically and can happen with or without gallstones.EtiologyAbout 95% of cholecystitis cases are calculous, caused by gallstones blocking the cystic duct, leading to bile accumulation and inflammation of the gallbladder...
29
01:17Gallbladder
3.2K
The gallbladder is a small, pear-shaped organ that plays a crucial role in our digestive system. Measuring about 10 cm in length, it is comparable in size to a kiwi fruit and is located in a hollow area on the lower surface of the liver. The gallbladder's primary function is to store and concentrate bile, a fluid produced by the liver that aids in digestion.
The gallbladder's anatomy consists of three regions: the fundus, body, and neck. Extending from the neck, the cystic duct joins...
The gallbladder's anatomy consists of three regions: the fundus, body, and neck. Extending from the neck, the cystic duct joins...
3.2K
01:26Endoscopic Procedures V: ERCP
7.2K
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a diagnostic procedure that combines endoscopy and fluoroscopy to diagnose and treat conditions related to the bile ducts, pancreatic ducts, and gallbladder. This procedure is beneficial for identifying and addressing blockages, gallstones, strictures, and tumors within the biliary or pancreatic systems. ERCP is both diagnostic and therapeutic, offering the ability to visualize and treat identified problems in one session.
Patient...
Patient...
7.2K
01:26Diseases of the Liver and Gallbladder
2.1K
Liver and gallbladder diseases are a significant health concern, with prominent conditions including cirrhosis, hepatitis, non-alcoholic fatty liver disease (NAFLD), and gallstones. Jaundice is a common manifestation of liver and biliary disease.
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
2.1K
01:25Acute Pancreatitis I: Introduction
24
Acute pancreatitis is the sudden inflammation of the pancreas caused by the early activation of digestive enzymes, leading to the autodigestion of pancreatic tissue. This results in local inflammation and, in severe cases, systemic complications.EtiologyUnderstanding the underlying causes is crucial, as identifying the etiology guides treatment and anticipates complications. Acute pancreatitis can be triggered by various factors, typically grouped into the following clinical categories.Biliary...
24
01:30Acute Pancreatitis II: Clinical Manifestations and Management
1.2K
Acute pancreatitis presents a complex medical emergency characterized by rapid onset inflammation of the pancreas, demanding timely diagnosis and management to prevent complications. The condition primarily manifests through severe upper abdominal pain that often radiates to the back. This pain intensifies following the consumption of fatty foods. Accompanying symptoms such as nausea, vomiting, abdominal distention, fever, dyspnea, cyanosis, and jaundice can vary in intensity but significantly...
1.2K