Case Report
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2005; 11(32): 5068-5071
Published online Aug 28, 2005. doi: 10.3748/wjg.v11.i32.5068
EUS diagnosis of ectopic opening of the common bile duct in the duodenal bulb: A case report
Miodrag Krstic, Bojan Stimec, Radmilo Krstic, Milenko Ugljesic, Srbislav Knezevic, Ivan Jovanovic
Miodrag Krstic, Radmilo Krstic, Milenko Ugljesic, Srbislav Knezevic, Ivan Jovanovic, Clinical Center of Serbia, Belgrade, Serbia and Montenegro
Bojan Stimec, Institute for Anatomy, School of Medicine, Belgrade, Serbia and Montenegro
Author contributions: All authors contributed equally to the work.
Correspondence to: Miodrag Krstic, Clinical Center of Serbia, Clinic for Gastroenterology, 2 Koste Todorovica, Belgrade 11000, Serbia and Montenegro. misa@tehnicom.net
Telephone: +381-11-361-5575 Fax: +381-11-361-5575
Received: February 22, 2005
Revised: April 5, 2005
Accepted: April 9, 2005
Published online: August 28, 2005
Abstract

Among the various congenital anomalies of the biliary system, an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain, followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS), which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery. As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain, choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.

Keywords: Ectopic opening; Common bile duct; Congenital anomaly; Endoscopic ultrasound