A Case Report of Double Common Bile Duct with Pancreaticobiliary Muljunction Deteced by CT after Intravenous Cholangiography

Yoshihiro Takaya, Takahiro Yasaka, Shinya Sano, Shinsuke Fujiwara and Ryouta Ohtsubo

Department of Surgery, Kamigotou Hospital

A 34-year old male suffering epigastralgia for some time was diagnosed with cholecystlithiasis in an annual medical checkup in September 2001 and admitted for surgery. Physical status and blood tests were normal. Abdominal ultrasonography and plane CT showed gallbladder calculosis and wall thicknning of the fundal portion, compatible with gallbladder adenomyomatosis with lithiasis. The confluence of the cystic duct and common bile duct showed a high junction pattern on CT after drip infusion venous cholangiography (DIC-CT). DIC-CT also detected an unusual structure to the left side of the common bile duct suspected as an accessory common bile duct. Endoscopic retrograde pancreaticocholangiography showed abnormal conjunctions of the accessory common bile duct to the normal pancreaticobiliary tract; one was a junction with the common hepatic duct on the opposite side of the cystic duct, and the another with the main pancreatic duct. From these radiographic findings, we diagnosed adenomyomatosis with lithiasis of the gallbladder complicated by a double common bile duct with pancreaticobiliary maljunction. The gallbladder was extracted by laparoscopic cholecystectomy.We confirmed the double common bile duct using intraoperative fluoroscopic cholangiography; contrast medium injected through the cystic duct filling the main common bile duct, passing through the bridging duct on the opposite side and accessory common bile duct, and the conjuncting with the main pancreatic duct. We ligated the accessory common bile duct to stop the mixture of bile juice and pancreatic juice, based on the possible correlation between this anomaly and abdominal symptoms. Pathological examination showed no evidence of neoplasmic change except for chronic inflammation in the resected gallbladder. The patient suffered no recurrent symptoms after surgery.

Key words
double common bile duct, DIC-CT, pancreaticobiliary maljunction

Reprint requests
Yoshihiro Takaya Department of Sugery, Kamigotou Hospital
1549-11 Aokata, Kamigotou, Minamimatsuura, Nagasaki, 857-4404 JAPAN

Accepted
September 22, 2004

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