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Common bile duct duplication: the more the murkier.

Arora A, Sureka B, Kasana V, Patidar Y, Bansal K - Saudi J Gastroenterol (2015 Jan-Feb)

Bottom Line: Congenital duplication of the common bile duct is an extremely rare anomaly of the biliary tract, which putatively represents failure of regression of the embryological double biliary system.Depending on the morphology of the duplicated bile duct, the anomaly can be classified into five distinct subtypes as per the modified classification (proposed by Choi et al).Among the five subtypes of bile duct duplication, type V duplication is considered to be the least common with only two previous cases of type Va variant reported in medical literature prior to the current report.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.

ABSTRACT
Congenital duplication of the common bile duct is an extremely rare anomaly of the biliary tract, which putatively represents failure of regression of the embryological double biliary system. Depending on the morphology of the duplicated bile duct, the anomaly can be classified into five distinct subtypes as per the modified classification (proposed by Choi et al). Among the five subtypes of bile duct duplication, type V duplication is considered to be the least common with only two previous cases of type Va variant reported in medical literature prior to the current report.

No MeSH data available.


Related in: MedlinePlus

Thick slab (2D) MRCP image showing duplicated extrahepatic bile ducts running parallel (arrowheads) and reuniting into a common channel (dotted arrow) at the level of the head of the pancreas consistent with type Va double common bile duct. In addition, a filling-defect suggestive of an obstructive calculus is seen in the common channel just above the ampulla (arrow). The cystic duct is inserting into the right-sided bile duct
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Figure 1: Thick slab (2D) MRCP image showing duplicated extrahepatic bile ducts running parallel (arrowheads) and reuniting into a common channel (dotted arrow) at the level of the head of the pancreas consistent with type Va double common bile duct. In addition, a filling-defect suggestive of an obstructive calculus is seen in the common channel just above the ampulla (arrow). The cystic duct is inserting into the right-sided bile duct

Mentions: A 52-year-old woman, a previously diagnosed case of cryptogenic cirrhosis, presented with progressive worsening of jaundice and unrelenting right upper quadrant abdominal pain. Previously, her work-up for known etiologies of chronic liver disease (including hepatitis viral serology, autoantibodies such as antinuclear and antismooth muscle antibodies, serum ferritin, and ceruloplasmin levels) were negative. At present admission, her liver biochemistry revealed total, direct, and indirect bilirubin of 7.8, 4.1, and 3.7 mg/dL, respectively. Serum alkaline phosphatase was elevated at 264 IU/L, whereas alanine aminotransferase and aspartate aminotransferase were only marginally raised. Ultrasonography of abdomen revealed biliary dilatation with suspicion of an intraductal calculus impacted at the ampulla. Interestingly, subsequent magnetic resonance cholangiopancreatography (MRCP) revealed duplication of the extrahepatic bile duct [Figure 1]. The duplicated bile ducts were running parallel and were seen to reunite into a common channel at the level of the head of the pancreas consistent with type-Va double common bile duct according to Choi et al. Additionally, a filling-defect suggestive of an obstructive calculus was seen in the common channel just above the ampulla causing obstruction and upstream biliary dilatation (arrow). No associated anomaly of the gallbladder was evident. The cystic duct was seen inserting into the right-sided bile duct. The biliopancreatic junction was unremarkable.


Common bile duct duplication: the more the murkier.

Arora A, Sureka B, Kasana V, Patidar Y, Bansal K - Saudi J Gastroenterol (2015 Jan-Feb)

Thick slab (2D) MRCP image showing duplicated extrahepatic bile ducts running parallel (arrowheads) and reuniting into a common channel (dotted arrow) at the level of the head of the pancreas consistent with type Va double common bile duct. In addition, a filling-defect suggestive of an obstructive calculus is seen in the common channel just above the ampulla (arrow). The cystic duct is inserting into the right-sided bile duct
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4355865&req=5

Figure 1: Thick slab (2D) MRCP image showing duplicated extrahepatic bile ducts running parallel (arrowheads) and reuniting into a common channel (dotted arrow) at the level of the head of the pancreas consistent with type Va double common bile duct. In addition, a filling-defect suggestive of an obstructive calculus is seen in the common channel just above the ampulla (arrow). The cystic duct is inserting into the right-sided bile duct
Mentions: A 52-year-old woman, a previously diagnosed case of cryptogenic cirrhosis, presented with progressive worsening of jaundice and unrelenting right upper quadrant abdominal pain. Previously, her work-up for known etiologies of chronic liver disease (including hepatitis viral serology, autoantibodies such as antinuclear and antismooth muscle antibodies, serum ferritin, and ceruloplasmin levels) were negative. At present admission, her liver biochemistry revealed total, direct, and indirect bilirubin of 7.8, 4.1, and 3.7 mg/dL, respectively. Serum alkaline phosphatase was elevated at 264 IU/L, whereas alanine aminotransferase and aspartate aminotransferase were only marginally raised. Ultrasonography of abdomen revealed biliary dilatation with suspicion of an intraductal calculus impacted at the ampulla. Interestingly, subsequent magnetic resonance cholangiopancreatography (MRCP) revealed duplication of the extrahepatic bile duct [Figure 1]. The duplicated bile ducts were running parallel and were seen to reunite into a common channel at the level of the head of the pancreas consistent with type-Va double common bile duct according to Choi et al. Additionally, a filling-defect suggestive of an obstructive calculus was seen in the common channel just above the ampulla causing obstruction and upstream biliary dilatation (arrow). No associated anomaly of the gallbladder was evident. The cystic duct was seen inserting into the right-sided bile duct. The biliopancreatic junction was unremarkable.

Bottom Line: Congenital duplication of the common bile duct is an extremely rare anomaly of the biliary tract, which putatively represents failure of regression of the embryological double biliary system.Depending on the morphology of the duplicated bile duct, the anomaly can be classified into five distinct subtypes as per the modified classification (proposed by Choi et al).Among the five subtypes of bile duct duplication, type V duplication is considered to be the least common with only two previous cases of type Va variant reported in medical literature prior to the current report.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Institute of Liver and Biliary Sciences (ILBS), New Delhi, India.

ABSTRACT
Congenital duplication of the common bile duct is an extremely rare anomaly of the biliary tract, which putatively represents failure of regression of the embryological double biliary system. Depending on the morphology of the duplicated bile duct, the anomaly can be classified into five distinct subtypes as per the modified classification (proposed by Choi et al). Among the five subtypes of bile duct duplication, type V duplication is considered to be the least common with only two previous cases of type Va variant reported in medical literature prior to the current report.

No MeSH data available.


Related in: MedlinePlus