A Vary Rare Congenital Anomaly of the Adult Biliary System- Type Vb Double Common Bile Duct

Abstract

Introduction: Duplication of the common bile duct (DCBD) is a rare anomaly especially in the western world; more cases have been reported in Asia. Based on the modified classification proposed by Choi et al. there are five subtypes of this anomaly. Type V is the least common with only five cases reported and one reported as type Vb). Case Report: We present a 57-year-old Hispanic male seen for evaluation of choledocholithiasis. He had a history of cholecystectomy for cholelithiasis and cholecystitis. His only complaint was an occasional feeling of being distended and gassy. No family history of biliary problems was reported. Physical examination was not remarkable. Routine biochemistry revealed no abnormalities of hepatic or renal function with normal bilirubin, alkaline phosphate and c-reactive protein. Magnetic resonance cholangiopancreatography (MRCP) revealed duplicated extrahepatic bile ducts running parallel with proximal communication and a common channel distally as it enters the duodenum. The finding is consistent with type Vb double common bile duct according to the Choi classification. The extrahepatic biliary ducts measured 7.5 and 4.5mm. Two filling defects were seen in the 7.5 mm extrahepatic biliary duct suspicious for choledocholithiasis. On Endoscopic retrograde cholangiopancreatography (ERCP), the finding of MRCP was confirmed, and two stones were extracted from the dominant common bile duct. No complications occurred after the procedure and patient was doing well three months later. Conclusion: This is the second case of type Vb DCBD in a Hispanic male complicated by choledocholithiasis. The awareness of this anomaly is essential due to its association with congenital conditions like choledochal cysts, biliary atresia or complications like choledocholithiasis and malignancy. Moreover, it is important to identify this anomaly to prevent intraoperative injury to the other extrahepatic ducts.Figure 1Figure 2