Duplication of the Common Bile Duct Associated with an Abnormal Pancreatico-Bile Duct Junction. Case Report and Literature Review

Abstract

Duplication of the common bile duct (CBD) is an uncommon congenital anomaly of the extrahepatic biliary tree; less than 150 cases have been reported to date. The anomaly is characterized by the presence of two ducts—usually one main common bile duct and an accessory bile duct. We present one such case in a 7-year-old girl, where the proximal CBD divided into two separate channels for a short distance and re-united distally to open as a common channel into the second part of duodenum. The main pancreatic duct opened proximally into the medial limb of the anomalous CBD, forming an abnormal pancreatico-bile duct junction (APBDJ). According to the accepted classification, this is a Type Va CBD duplication. The patient also had cholelithiasis and calculi in the medial limb and distal common channel. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, with removal of the gallstones, followed by laparoscopic cholecystectomy. Preoperative radiological imaging, such as ERCP and magnetic resonance cholangiopancreatography (MRCP) are strongly recommended for diagnosis of this condition. Surgery may not be needed for all patients and should be tailored to suit each individual case. This case is presented for its rarity, in the hope that it will contribute to the literature coverage.