Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 6, 2021; 9(19): 5332-5338
Published online Jul 6, 2021. doi: 10.12998/wjcc.v9.i19.5332
Ectopic opening of the common bile duct into the duodenal bulb with recurrent choledocholithiasis: A case report
Hao Xu, Xin Li, Ke-Xiang Zhu, Wen-Ce Zhou
Hao Xu, Ke-Xiang Zhu, Wen-Ce Zhou, The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou 730000, Gansu Province, China
Xin Li, The First Clinical Medical School of Lanzhou University, Lanzhou University, Lanzhou 730000, Gansu Province, China
Author contributions: Xu H wrote the manuscript and acquired patient information; Li X and Zhu KX performed the literature review and follow-up; Zhou WC revised the manuscript; all authors have read and approved the final manuscript.
Supported by The Key Research and Development Program of Gansu, No. 17YF1FA128; and Lanzhou Science and Technology Bureau Innovation and Entrepreneurship Talent Program, No. 2017-RC-37.
Informed consent statement: Written informed consent was obtained from the patient for publication of this case 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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen-Ce Zhou, MD, PhD, Professor, Surgeon, The Fourth Department of General Surgery, The First Hospital of Lanzhou University, Donggang West Road No. 1 Lanzhou 730000, Gansu Province, China. zhouwc129@163.com
Received: February 28, 2021
Peer-review started: February 28, 2021
First decision: April 14, 2021
Revised: April 22, 2021
Accepted: May 20, 2021
Article in press: May 20, 2021
Published online: July 6, 2021
Abstract
BACKGROUND

Ectopic opening of the common bile duct is a condition with low incidence. Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis. Patients with atypical symptoms and imaging findings are easily misdiagnosed; moreover, it is difficult to retrieve stones by endoscopic retrograde cholangiopancreatography, and common bile duct stones are prone to postsurgical recurrence.

CASE SUMMARY

A 45-year-old male patient presented with “intermittent upper abdominal pain and elevated liver enzymes for 1 wk”. Transabdominal ultrasound indicated dilation of the common bile duct and the presence of stones. Magnetic resonance imaging showed that the common bile duct was dilated with stones and that its opening was ectopic. Endoscopic retrograde cholangiopancreatography revealed an abnormal opening of the common bile duct into the duodenal bulb and the presence of common bile duct stones. Laparoscopic extrahepatic choledochectomy and hepatoenteric anastomosis were performed. After surgery, the patient recovered well and was discharged. The patient has been followed up for 2 years since the operation. He has not experienced stone recurrence, and his liver function and quality of life are good.

CONCLUSION

Improved understanding of ectopic opening of the common bile duct is needed for clinicians to provide patients with appropriate treatment.

Keywords: Ectopic opening of the common bile duct, Choledocholithiasis, Cholangiojejunostomy, Treatment, Laparoscopic surgery, Case report

Core Tip: Ectopic opening of the common bile duct into the duodenal bulb is very rare. Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis. Furthermore, patients with atypical symptoms and imaging findings are easily misdiagnosed. This report describes a case of ectopic opening of the common bile duct into the duodenal bulb with recurrent choledocholithiasis. This report is expected to provide experience for the diagnosis and treatment of this condition by describing the clinical data of this patient with an ectopic opening of the common bile duct into the duodenal bulb.