Congenital left intrahepatic bile duct draining into gastric wall mimicking biliary reflux gastritis

Abstract

Abnormalities and variations of the biliary ducts are not rare. Most aberrant bile ducts eventually drain into the descending part of duodenum through the papilla of vater. However, drainage of the left hepatic bile duct into the stomach is extremely rare. A 29-year old man was admitted to the hospital with the diagnosis of biliary reflux gastritis. Comprehensive imaging modalities were performed including electronic endoscopy, endoscopic ultrasonography, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangio-pancreatography. Finally, congenital ectopic left intrahepatic bile duct draining into the stomach was found, which caused biliary reflux gastritis. The patient did not receive any surgery. Good recovery was achieved by medical treatment.

An Extremely Rare Bile Leakage: Aberrant Bile Duct in Left Triangular Ligament (Appendix Fibrosa Hepatis)

“…The bile ducts do not have a constant structure, so the surgeons can have undesired surprise during the gastrointestinal system surgery. To avoid these situations, it is necessary to use imaging methods for diagnosis of the biliary tract before surgery, especially in women [ 2 , 3 , 5 , 6 ]. It is somewhat more difficult to predict this situation in cases of previous gastric surgery, such as the one described by Iso et al [ 6 ].…”

“…We have not been able to perform endoscopic imaging because of the presence of Billroth-2 gastrectomy and Roux-en-Y gastrojejunostomy. Today, however, this difficulty can be overcome by MRCP examination [ 1 , 3 , 6 ]. We also used MRCP in this case where endoscopic imaging could not be done, and we diagnosed bile leak with this method.…”

“…Conservative approaches for the management of bile leakages and the need for surgical intervention may vary according to the anatomical localization and the amount of the leakage and the clinical condition of the patient [ 3 ]. In cases where the bile ducts can be reached by endoscopic method, papillotomy and/or stenting can be used to reduce the intraluminal pressure of the bile ducts and reduce the leakage and stop them completely.…”

“…Therefore, the structure of the bifurcation, especially the anatomy of the biliary tract, should be assessed very well before the operation, and possible ultrasonography, computed tomography, magnetic resonance cholangiopancreatography (MRCP), and endoscopic imaging methods should be used carefully [ 3 , 4 ]. Nevertheless, after all, there may be bile leakage.…”

“…Although the gallbladder surgery is performed commonly, bile leakage is seen after upper gastrointestinal system surgery for various reasons [ 5 ]. Endoscopic procedures and laparoscopic or open surgical interventions may be necessary, as well as conservative approaches such as waiting for spontaneous abortion of the leakage according to the patient's situation [ 3 , 5 , 6 ].…”