Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2021; 27(4): 371-376
Published online Jan 28, 2021. doi: 10.3748/wjg.v27.i4.371
Duplication of the common bile duct manifesting as recurrent pyogenic cholangitis: A case report
Jun Seong Hwang, Sung Woo Ko
Jun Seong Hwang, Internal Medicine, Inje University Haeundae Paik Hospital, Inje College of Medicine, Busan 48108, South Korea
Sung Woo Ko, Internal Medicine, Eunpyeong St. Mary's Hospital, Catholic University of Korea, Seoul 03312, South Korea
Author contributions: Hwang JS was the patient’s gastroenterologist, and contributed to manuscript drafting; Ko SW was responsible for the revision of the manuscript by providing important intellectual content.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Sung Woo Ko, MD, Assistant Professor, Internal medicine, Eunpyeong St. Mary's Hospital, Catholic University of Korea, 1021, Tongil-ro, Eunpyeong-gu, Seoul 03312, South Korea.
Received: November 23, 2020
Peer-review started: November 23, 2020
First decision: December 8, 2020
Revised: December 16, 2020
Accepted: January 8, 2021
Article in press: January 8, 2021
Published online: January 28, 2021

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.


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 cholangio-pancreatography (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 cholangiopancrea-tography 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.


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.

Keywords: Double common bile duct, Common bile duct disease, Choledocholithiasis, Cholangitis, Endoscopic retrograde cholangiopancreatography, Case report

Core Tip: Double common bile duct (DCBD) is an extremely rare congenital biliary tract anomaly. We present herein, a rare case of DCBD manifesting as a recurrent pyogenic cholangitis. It is substantial to establish complete stone clearance during endoscopic retrograde cholangiopancreatography because residual stone is a probable risk factor for recurrent cholangitis. However, DCBD, an extremely rare anomaly, can completely mask the presence of remnant bile duct stones for biliary endoscopists. In this case, recurrent cholangitis, which occurred immediately after bile duct stone clearance was a clue to recognize DCBD. Although this is a rare condition, our case highlights the importance of recognizing DCBD because stones in the unrecognized bile duct could make the patient’s prognosis critical.