An Unusual Cause of Double Duct Sign

Sharma, Malay; Mahadevan, Balakrishnan

doi:10.1053/j.gastro.2010.02.069

Cited by 10 publications

(5 citation statements)

References 3 publications

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“…There is only one case report in literature where double duct sign and hypertrophy of precapillary sphincter has been described on EUS in one patient of long standing opium addiction 7. The peculiar EUS findings in the present series were dilatation of CBD in all the cases while PD dilatation producing double duct sign was seen in six patients (40%) and increased SPV in 80% of patients.…”

Section: Discussioncontrasting

confidence: 50%

“…have described ulcerative and tumoral features in ampulla in opium addicts. Pre-sphincteric hypertrophy of ampulla was described in a case report by Malay and Balakrishnan 7. Routine abdominal US is much less sensitive than EUS to outline complete changes in pancreato-biliary system in opium addicts.…”

Section: Discussionmentioning

confidence: 99%

“…Dilated CBD is always seen in these patients while dilated pancreatic duct (PD) is seen in only a few patients. Except one case report7 there is no literature on endoscopic ultrasound (EUS) study of pancreato-biliary system in symptomatic opium addicts. In the present study, EUS findings of 15 opium addicts presenting with upper abdominal pain and dilated CBD and or PD on abdominal ultrasound (US) were reviewed and presented.…”

Section: Introductionmentioning

confidence: 99%

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Pancreato-biliary endoscopic ultrasound in opium addicts presenting with abdominal pain

et al. 2013

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Objective:Asymptomatic dilatation of bile duct and symptomatic sphincter of Oddi dysfunction have been reported in opium addicts. Except one case report, there is no report in the literature on endoscopic ultrasound (EUS) study of pancreato-biliary system in opium addicts. The aim of the present study was to report the EUS features of pancreato-biliary system in opium addicts presenting with abdominal pain.Patients and Methods:A total of 15 opium addicts presenting with upper abdominal pain and dilated common bile duct (CBD) and or pancreatic duct (PD) on abdominal ultrasound were included in this study. EUS findings of pancreato-biliary system were analyzed in these patients.Results:All the 15 patients were males (mean age 53.3 years) presented with upper abdominal pain. Mean duration of opium addiction was 20.1 years. On EUS CBD was dilated in all the patients while PD was dilated in six patients. Gall bladder, liver and pancreatic parenchyma was normal in all these patients. Surface area of papilla of Vater (SPV) was increased in 12 patients.Conclusion:Opium addiction causes obstruction at ampulla and produces dilatation of bile duct and PD. Bile duct dilatation was seen in all the patients while PD dilatation was seen in few patients. Increase in SPV was a peculiar finding and appears to be as a result of direct effect of opium on ampulla.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Pancreato-biliary endoscopic ultrasound in opium addicts presenting with abdominal pain

et al. 2013

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“…EUS can also help in the detection of hypertrophy of the muscular sphincter of Oddi as was seen in the index case. [ 6 ]…”

Section: Discussionmentioning

confidence: 99%

Opium-related sphincter of Oddi dysfunction causing double duct sign

et al. 2016

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Double duct sign where there is a simultaneous dilatation of both the common bile duct (CBD) and pancreatic duct is usually associated with sinister causes like malignancies of pancreatic head or ampulla. Occasionally, benign causes like chronic pancreatitis or sphincter of Oddi dysfunction (SOD) may cause double duct sign. Chronic opium abuse is a rare cause of the double duct sign, and endoscopic ultrasound (EUS) findings of this rare entity have been occasionally reported. We report about a 54-year-old male with a history of chronic alcohol and opioid abuse evaluated for episodes of abdominal pain and found to have opioid-related SOD and improved with biliary sphincterotomy. EUS was done to rule out malignancy and revealed hypoechoic prominence around terminal CBD suggestive of hypertrophied muscle.

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“…Nevertheless, the incidence of tumours in DDS incidentally found when associated with normal LFTs remains unclear, and the incidence is increasing due to the almost ubiquitous use of cross-sectional imaging. Benign causes for DDS were also reported including CBD stones [ 4 ], chronic pancreatitis [ 5 ], and sphincter of Oddi dysfunction [ 6 , 7 ]. DDS often results in multiple discussions at multidisciplinary team meetings (MDT) and further investigations including endoscopic ultrasound (EUS) and/or surveillance scans.…”

Section: Introductionmentioning

confidence: 99%

Clinical Significance and Resource Burden of Double Duct Sign in Non-jaundiced Patients

Mahmoud Askar,

Zahir Hussain,

Chavda

et al. 2024

Cureus

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Aim The study aims to determine the incidence of malignancy at presentation and subsequent risk of malignancy (at 12 months follow-up) in a cohort of patients with double duct sign (DDS) on cross-sectional imaging but no visible stigmata of jaundice. The study also correlates malignancy with liver enzyme dysfunction and estimates the resource burden incurred during the investigation of these patients. Methods A search for the key term "double duct sign" was undertaken in the radiological database of a tertiary hepatopancreatobiliary (HPB) centre between March 2017 and March 2022. Radiological reports, clinic letters, blood results, and multidisciplinary team meeting (MDT) outcomes were reviewed during this period and at one year. The national tariff payment system was reviewed to identify tariffs for different investigations required for the cohort and to calculate the total cost incurred. Results Ninety-seven patients with DDS were identified. Sixty-four patients (66%) had a normal bilirubin (0-21 µmol/L) at presentation and were included in the analysis. Seven patients (10.9%) were diagnosed with malignant peri-ampullary tumours, and 21 (32.8%) were diagnosed with benign diseases. In 34 patients (53%) with DDS, the underlying cause remained uncharacterised. Most patients had mild abnormalities of liver enzymes, but two patients (4.3%) were diagnosed with malignant peri-ampullary tumours despite having normal serological values. Patients who had a benign diagnosis and/or who had cancer excluded without a definitive diagnosis did not go on to develop a malignancy at 12 months follow-up. However, in those patients where the underlying aetiology could not be characterised, extended surveillance was required with a total of 80 MDT discussions and multiple surveillance scans (103 CT and 65 MRI scans). Twenty-six patients underwent endoscopic ultrasound (EUS) with three patients requiring more than one EUS examination (29 investigations in total). The cost of these investigations was £38,926.89. Conclusion This study confirms that DDS even in patients without clinical jaundice or with normal liver enzymes requires careful investigation to exclude malignancy despite the resource burden this entails. This supports previously reported results in the literature, and despite the increased use of cross-sectional imaging, DDS remains a clinically significant finding. Large cohort risk stratification studies would be useful to determine clinical urgency and allow the appropriate allocation of resources.

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An Unusual Cause of Double Duct Sign

Cited by 10 publications

References 3 publications

Pancreato-biliary endoscopic ultrasound in opium addicts presenting with abdominal pain

Pancreato-biliary endoscopic ultrasound in opium addicts presenting with abdominal pain

Opium-related sphincter of Oddi dysfunction causing double duct sign

Clinical Significance and Resource Burden of Double Duct Sign in Non-jaundiced Patients

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