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Double common bile duct associated with pancreaticobiliary maljunction
Kenta Yamada1, Takuya Ishikawa1, Eizaburo Ohno1
1Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Nagoya Journal of Medical Science
|September 23, 2021
Summary
A patient with acute pancreatitis presented with an unusual bile duct anatomy, a rare pancreaticobiliary maljunction. Treatment involved managing a bile duct obstruction and subsequent gallbladder removal, with ongoing monitoring for cancer risk.
Area of Science:
- Gastroenterology and Hepatology
- Surgical Anatomy
- Oncology
Background:
- Acute pancreatitis can present with complex biliary anomalies.
- Pancreaticobiliary maljunction (PBM) is a congenital condition affecting the pancreatic and bile ducts.
- Biliary anomalies can increase the risk of complications like pancreatitis and cholangiocarcinoma.
Observation:
- A 45-year-old female with acute pancreatitis was found to have two extrahepatic bile ducts on computed tomography.
- Magnetic resonance cholangiopancreatography indicated a bile duct stone, and endoscopic retrograde cholangiopancreatography confirmed a pancreaticobiliary maljunction.
- A protein plug obstructing the bile duct was identified and removed following sphincterotomy.
Findings:
- The patient exhibited a rare anatomical variant of two extrahepatic bile ducts joining at the liver hilum, associated with PBM.
- Laparoscopic cholecystectomy was performed without resection of the extrahepatic bile ducts.
- A protein plug was successfully drained from the bile duct after sphincterotomy.
Implications:
- This case highlights the importance of recognizing rare biliary ductal anomalies in patients with pancreatitis.
- Management requires careful consideration of the underlying anatomical abnormality and potential long-term risks.
- Long-term follow-up is crucial due to the increased risk of carcinogenesis associated with pancreaticobiliary maljunction.
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