Presence of Courvoisier's or double duct signs in a jaundiced patient is suggestive of malignant obstruction of the pancreaticobiliary ductal system.The oncologic impact of the simultaneous occurrence of these sig...Presence of Courvoisier's or double duct signs in a jaundiced patient is suggestive of malignant obstruction of the pancreaticobiliary ductal system.The oncologic impact of the simultaneous occurrence of these signs on the survival of patients with periampullary cancer is unknown.We report a case of obstructive jaundice secondary to an ampullary cancer demonstrating the Courvoisier's sign on clinical examination and a double duct sign on imaging.The patient underwent a pancreaticoduodenectomy which confirmed an ampullary adenocarcinoma.展开更多
Double common bile duct （DCBD） is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct...Double common bile duct （DCBD） is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct （ACBD） opens in different parts of upper gastrointestinal tract （stomach, duodenum, ductus pancreaticus or septum）. This anomaly is of great importance since it is often associated with biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction （APBJ） and upper gastrointestinal tract malignancies. We recently recognized a rare case of DCBD associated with APB3 with lithiasis in better developed common bile duct. The opening site of ACBD was in the pancreatic duct. The anomaly was suspected by transabdominal ultrasonography and finally confirmed by endoscopic retrograde cholangiopancreatography （ERCP） followed by endoscopic sphincterotomy and stone extraction. According to the literature, the existence of DCBD with the opening of ACBD in the pancreatic duct is most frequently associated with APB3 and gallbladder carcinoma. In case of DCBD, the opening site of ACBD is of greatest clinical importance because of its close implications with concomitant pathology. The adequate diagnosis of this rare anomaly is significant since the operative complications may occur in cases with DCBD which is not recognized prior to surgical treatment.展开更多
BACKGROUND Duplication of the extrahepatic bile duct(DCBD)is an extremely rare congenital anomaly of the biliary system.There are five types of DCBD according to the latest classification.Among them,Type V is characte...BACKGROUND Duplication of the extrahepatic bile duct(DCBD)is an extremely rare congenital anomaly of the biliary system.There are five types of DCBD according to the latest classification.Among them,Type V is characterized by single drainage of the extrahepatic bile ducts.Reports on DCBD Type V are scarce.CASE SUMMARY A 77-year-old woman presented with recurrent epigastric pain but without fever or chills.Computed tomography revealed a dilated common bile duct(CBD)that harboured multiple choledocholithiasis.Endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the stones were extracted using a Dormia basket.She was discharged without any complications;however,she visited the emergency department a day after she was discharged due to epigastric pain and fever.Laboratory findings were suggestive of cholestasis.After urgent ERCP for stone removal,magnetic resonance cholangiopancreatography was performed to evaluate remnant choledocholithiasis.Magnetic resonance cholangiopancreatography revealed a DCBD Type Va and remnant choledocholithiasis in the right CBD.Both CBDs were accessed,and the stones were cleared successfully during a subsequent ERCP.CONCLUSION In this article,we report an extremely rare case of DCBD manifesting as recurrent pyogenic cholangitis.This case highlights the importance of recognizing DCBD because stones in the unrecognized bile duct could make the patient’s prognosis critical.展开更多
文摘Presence of Courvoisier's or double duct signs in a jaundiced patient is suggestive of malignant obstruction of the pancreaticobiliary ductal system.The oncologic impact of the simultaneous occurrence of these signs on the survival of patients with periampullary cancer is unknown.We report a case of obstructive jaundice secondary to an ampullary cancer demonstrating the Courvoisier's sign on clinical examination and a double duct sign on imaging.The patient underwent a pancreaticoduodenectomy which confirmed an ampullary adenocarcinoma.
文摘Double common bile duct （DCBD） is a rare congenital anomaly in which two common bile ducts exist. One usually has normal drainage into the papilla duodeni major and the other usually named accessory common bile duct （ACBD） opens in different parts of upper gastrointestinal tract （stomach, duodenum, ductus pancreaticus or septum）. This anomaly is of great importance since it is often associated with biliary lithiasis, choledochal cyst, anomalous pancreaticobiliary junction （APBJ） and upper gastrointestinal tract malignancies. We recently recognized a rare case of DCBD associated with APB3 with lithiasis in better developed common bile duct. The opening site of ACBD was in the pancreatic duct. The anomaly was suspected by transabdominal ultrasonography and finally confirmed by endoscopic retrograde cholangiopancreatography （ERCP） followed by endoscopic sphincterotomy and stone extraction. According to the literature, the existence of DCBD with the opening of ACBD in the pancreatic duct is most frequently associated with APB3 and gallbladder carcinoma. In case of DCBD, the opening site of ACBD is of greatest clinical importance because of its close implications with concomitant pathology. The adequate diagnosis of this rare anomaly is significant since the operative complications may occur in cases with DCBD which is not recognized prior to surgical treatment.
文摘BACKGROUND Duplication of the extrahepatic bile duct(DCBD)is an extremely rare congenital anomaly of the biliary system.There are five types of DCBD according to the latest classification.Among them,Type V is characterized by single drainage of the extrahepatic bile ducts.Reports on DCBD Type V are scarce.CASE SUMMARY A 77-year-old woman presented with recurrent epigastric pain but without fever or chills.Computed tomography revealed a dilated common bile duct(CBD)that harboured multiple choledocholithiasis.Endoscopic retrograde cholangiopancreatography(ERCP)was performed,and the stones were extracted using a Dormia basket.She was discharged without any complications;however,she visited the emergency department a day after she was discharged due to epigastric pain and fever.Laboratory findings were suggestive of cholestasis.After urgent ERCP for stone removal,magnetic resonance cholangiopancreatography was performed to evaluate remnant choledocholithiasis.Magnetic resonance cholangiopancreatography revealed a DCBD Type Va and remnant choledocholithiasis in the right CBD.Both CBDs were accessed,and the stones were cleared successfully during a subsequent ERCP.CONCLUSION In this article,we report an extremely rare case of DCBD manifesting as recurrent pyogenic cholangitis.This case highlights the importance of recognizing DCBD because stones in the unrecognized bile duct could make the patient’s prognosis critical.
