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Ari D, Ödemiş B, Başpinar B, Atay A, Erdoğan Ç. Ectopic Opening of Common Bile Duct to Duodenal Bulb: A Single Tertiary Center Experience. Surg Laparosc Endosc Percutan Tech 2023; 33:640-644. [PMID: 37725829 DOI: 10.1097/sle.0000000000001219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/31/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The ectopic opening of the common bile duct(CBD) into the duodenal bulb is a rare biliary anomaly. The study aimed to reveal the experience with clinical and endoscopic outcomes in these patients. MATERIALS AND METHODS This study was conducted on 57 consecutive patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for ectopic opening of the CBD into the duodenal bulb at our institution between 2010 and 2020. RESULTS The median age was 59 years (49 males). A total of 146 ERCP procedures were performed (once in 26 patients and 2 or more times in 31 patients). Ten patients had a history of unsuccessful ERCP in an external center. The median follow-up time was 14.6 months. All patients had a slit-like opening of the CBD into the duodenal bulb, apical stenosis, and hook-shaped distal CBD. ERCP findings were CBD stone or dilatation in 55 patients and post-cholecystectomy biliary leakage in 2 patients. Balloon dilatation was performed for apical stenosis in 7 patients and distal CBD stenosis in 26 patients. During the first ERCP session, biliary stent/nasobiliary drainage was placed in 37 patients, and CBD stones were extracted in 19 patients without stenting. Biliodigestive anastomosis was applied to 13 patients, 5 of whom had recurrent cholangitis, 7 required recurrent ERCP, and one was due to the technical difficulty of ERCP. CONCLUSIONS Ectopic biliary opening should be remembered if the papilla cannot be seen in its usual place in a patient with apical stenosis. ERCP should be performed in experienced hands, and surgery should be considered in the need for recurrent ERCP.
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Affiliation(s)
- Derya Ari
- Department of Gastroenterology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Ectopic Opening of the Bile Duct Into the Duodenal Bulb: Complications of Biliary Drainage. ACG Case Rep J 2023; 10:e00973. [PMID: 36819478 PMCID: PMC9935988 DOI: 10.14309/crj.0000000000000973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 01/04/2023] [Indexed: 02/17/2023] Open
Abstract
Ectopic opening of the common bile duct is a rare anatomic variant that is associated with increased risk of complications such as cholangitis, peptic ulcer disease, and even cholangiocarcinoma. Ectopic opening of the common bile duct into the duodenal bulb is a rare form of ectopic opening of the common bile duct accounting for 0.1%-2.7% of cases of anomalous biliary drainage. Identification of such pathology is important because of its varied presentation and considerable operative and procedural implications. We report a rare case of duodenal bulb opening of the common bile duct in a patient who presented with cholangitis.
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Karabulut Ü, Üzel A, Yolaçan R, Uçmak F, Kaya M. Ectopic Opening of Common Bile Duct into Duodenal Bulb and Gastric Antrum and Its Importance. ARCHIVES OF IRANIAN MEDICINE 2022; 25:706-711. [PMID: 37542403 PMCID: PMC10685873 DOI: 10.34172/aim.2022.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 09/08/2021] [Indexed: 08/06/2023]
Abstract
BACKGROUND Ectopic opening of the common bile duct (CBD) is extremely rare, and its importance has not been adequately defined. The aim of our study is to present the characteristics of patients with this abnormality. METHODS This retrospective study was conducted in a tertiary center in Dicle University Hospital, Diyarbakır, Turkey, between October 2008 and December 2020. We present clinical, laboratory, endoscopic and cholangiographic features as well as the success rate of therapeutic interventions of consecutive patients with this abnormality undergoing endoscopic retrograde cholangiopancreatography (ERCP). RESULTS Ectopic opening of the CBD was identified in 29 (21 men; mean age 62) out of 3872 (0.74%) patients. There was a history of cholecystectomy in 14 (48%) and recurrent acute cholangitis in 20 (69%) patients. We found peptic ulcer in 13 (45%) and duodenal deformity associated with apical stenosis in 21 (72%) patients. Opening site was seen as abnormal in all patients, and it opened into the antrum in 2 (6.8%) and into the first part of the duodenum in 27 (93%) patients. Copious amount of bile and/ or bile sediment in the stomach were seen in all patients. We observed dilatation in both intrahepatic and extrahepatic bile ducts together with tapered narrowing and a hook-shaped distal end of CBD in all patients. There was bile stone in 26 (89%) and sludge in 3 (10%) patients. Sphincterotomy was not performed in any patients because there was not enough incision distance. Balloon dilatation was performed for extraction of stone and sludge in all patients. Complete stone extraction was achieved in only 7 out of 26 (27%) patients. CONCLUSION Ectopic opening of CBD is usually associated with gastroduodenal and bile ducts disease. Endoscopic treatment is unsatisfactory in most patients with this abnormality.
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Affiliation(s)
- Ümit Karabulut
- Department of Gastroenterology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Ali Üzel
- Department of Gastroenterology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Ramazan Yolaçan
- Department of Gastroenterology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Feyzullah Uçmak
- Department of Gastroenterology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
| | - Muhsin Kaya
- Department of Gastroenterology, Dicle University, Faculty of Medicine, Diyarbakır, Turkey
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Alkarboly T, Gharib DT, Salih KM, Mustafa SM, Salih AM, Kakamad FH. Ectopic papilla of Vater in the pylorus presenting with cholangitis: A case report with literature review. Int J Surg Case Rep 2022; 93:106887. [PMID: 35305424 PMCID: PMC8928074 DOI: 10.1016/j.ijscr.2022.106887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/25/2022] [Accepted: 02/26/2022] [Indexed: 10/25/2022] Open
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Kobayashi K, Murayama M, Sugasawa H, Nishikawa M, Nishiyama K, Takeo H. Duodenal stenosis associated with an ectopic opening of the common bile duct into the duodenal bulb: a case report. Surg Case Rep 2021; 7:257. [PMID: 34914022 PMCID: PMC8677856 DOI: 10.1186/s40792-021-01351-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background Ectopic opening of the common bile duct is a rare congenital biliary anomaly. Herein, we present a case of duodenal stenosis with ectopic opening of the common bile duct into the duodenal bulb. Case presentation A 54-year-old man was referred with fever, nausea, and vomiting. He had experienced epigastric pain several times over the past 30 years. Endoscopy showed a post-bulbar ulcer, a submucosal tumor of the duodenum, and a small opening with bile secretion. Contrast duodenography revealed duodenal stenosis and bile reflux with a common bile duct deformity. Pancreatoduodenectomy was performed because of the clinical suspicion of a biliary neoplasm or groove pancreatitis. The resected specimen showed an ectopic opening of the common bile duct into the duodenal bulb and no tumor. Conclusions Ectopic opening of the common bile duct into the duodenal bulb is complicated by a duodenal ulcer, deformity, and stenosis mimicking groove pancreatitis or pancreatic tumors. Although rare, we should be aware of this anomaly for an accurate diagnosis.
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Affiliation(s)
- Kazuki Kobayashi
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan.
| | - Michinori Murayama
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Hidekazu Sugasawa
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Makoto Nishikawa
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Kiyoshi Nishiyama
- Department of Surgery, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
| | - Hiroaki Takeo
- Department of Diagnostic Pathology, Self-Defense Forces Central Hospital, 1-2-24 Ikejiri, Setagaya, 154-0001, Japan
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Xu H, Li X, Zhu KX, Zhou WC. Ectopic opening of the common bile duct into the duodenal bulb with recurrent choledocholithiasis: A case report. World J Clin Cases 2021; 9:5332-5338. [PMID: 34307586 PMCID: PMC8283612 DOI: 10.12998/wjcc.v9.i19.5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/22/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ectopic opening of the common bile duct is a condition with low incidence. Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis. Patients with atypical symptoms and imaging findings are easily misdiagnosed; moreover, it is difficult to retrieve stones by endoscopic retrograde cholangiopancreatography, and common bile duct stones are prone to postsurgical recurrence.
CASE SUMMARY A 45-year-old male patient presented with “intermittent upper abdominal pain and elevated liver enzymes for 1 wk”. Transabdominal ultrasound indicated dilation of the common bile duct and the presence of stones. Magnetic resonance imaging showed that the common bile duct was dilated with stones and that its opening was ectopic. Endoscopic retrograde cholangiopancreatography revealed an abnormal opening of the common bile duct into the duodenal bulb and the presence of common bile duct stones. Laparoscopic extrahepatic choledochectomy and hepatoenteric anastomosis were performed. After surgery, the patient recovered well and was discharged. The patient has been followed up for 2 years since the operation. He has not experienced stone recurrence, and his liver function and quality of life are good.
CONCLUSION Improved understanding of ectopic opening of the common bile duct is needed for clinicians to provide patients with appropriate treatment.
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Affiliation(s)
- Hao Xu
- The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Xin Li
- The First Clinical Medical School of Lanzhou University, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Ke-Xiang Zhu
- The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Wen-Ce Zhou
- The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
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Hong J, Pan W, Zuo W, Wang A, Zhu L, Zhou X, Zhou X, Li G, Liu Z, Liu P, Zhen H, Zhu Y, Ma J, Yuan J, Shu X, Zhu Y, Lu N, Chen Y. Efficacy and safety of therapeutic ERCP in patients with ectopic papilla of Vater. Medicine (Baltimore) 2020; 99:e18536. [PMID: 31895789 PMCID: PMC6946525 DOI: 10.1097/md.0000000000018536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
It remains challenging for endoscopists to manage pancreaticobiliary diseases in patients with ectopic papilla of Vater by endoscopic retrograde cholangiopancreatography (ERCP). The present study sought to evaluate the efficacy and safety of ERCP for this issue.Consecutive patients with ectopic papilla of Vater who underwent initial ERCP due to pancreaticobiliary diseases were retrospectively analyzed.One hundred seven patients with ectopic papilla of Vater were included. The success rate of cannulation was 83.2%. Endoscopic sphincterotomy, endoscopic papillary balloon dilation, and mechanical lithotripsy were performed in 12 (11.2%), 25 (23.4%), and 1 (0.9%) patients, respectively. The technical success rate was 83.2%; of these, endoscopic nasobiliary drainage, endoscopic retrograde biliary drainage, endoscopic retrograde pancreatic drainage, and stone extraction was conducted in 61 (57.0%), 17 (15.9%), 5 (4.7%), and 45 (42.1%) patients, respectively. Bile duct stone size ≥1 cm, number ≥2, and duodenum stenosis were risk factors for stone extraction inability. Adverse events occurred in 20 (18.7%) patients, including post-ERCP pancreatitis (3.7%), hyperamylasemia (12.1%), and infection of biliary tract (2.8%); all of the adverse events were mild and alleviated by conventional therapies.ERCP is an appropriate choice for pancreaticobiliary diseases in patients with ectopic papilla of Vater due to its high efficacy and safety. Bile duct stone size ≥1 cm, number ≥2, and duodenum stenosis increase difficulties for stone extraction.
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Affiliation(s)
| | | | - Wei Zuo
- Department of Respiratory Medicine
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- Department of Gastroenterology
| | | | | | | | - Jianhui Yuan
- Endoscopy Center
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xu Shu
- Department of Gastroenterology
| | - Yin Zhu
- Department of Gastroenterology
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