Ectopic opening of the common bile duct and duodenal stenosis: an overlooked association

Abstract

BackgroundEctopic opening of the common bile duct into the duodenal bulb (EO-CBD-DB) is a rare disease that may be complicated by duodenal ulcer, deformity, stenosis and biliary stones. The aim of this study is to report clinical presentations, endoscopic diagnosis and treatment of this entity as well as to investigate its association with duodenal stenosis.MethodsGastroduodenoscopic findings and radiological imaging were evaluated for ectopic papilla and duodenal stenosis. Diagnostic methods, endoscopic procedures and long-term outcomes of the endoscopic treatment were presented.ResultsEO-CBD-DB was found in 74 (77.1%) of the 96 patients with duodenal deformity/stenosis (79 male, 17 female, mean age: 58.5, range: 30-87 years). The papilla with normal appearance was retracted to the bulb in 11 while it was at its usual location in the remaining 11. The history of biliodigestive surgery was more common in patients with EO-CBD-DB who were frequently presented with the common bile duct stone-related symptoms than the other patients. Thirteen (17.6%) of the patients with EO-CBD-DB were referred to surgery. Endoscopic treatment was completed in 60 (81.1%) patients after an average of 1.7 (range: 1-6) procedures. These patients were on follow-up for 24.8 (range: 2-46) months. Endoscopic intervention was required in 12 (20%) of them because of recurrent biliary problems. Treatment of the patient who had stricture due to biliary injury during laparoscopic cholecystectomy is still continued.ConclusionsThe presence of EO-CBD-DB should be considered particularly in middle-aged male patients who have duodenal deformity/stenosis. Endoscopic treatment is feasible in these patients. The long-term outcomes of endoscopic therapy need to be compared with surgical treatment.

Duodenal stenosis associated with an ectopic opening of the common bile duct into the duodenal bulb: a case report

“…Bile reflux into the duodenal bulb causes an increase in pH. At high pH, bile acids may cause gastric and duodenal bulb mucosal damage [ 7 , 8 , 11 , 12 , 15 ]. Previous reports also suggest that bicarbonate in pancreatic secretion contributes to the increase in the pH in the bulb, leading to recurrent duodenal ulcer and deformity [ 12 ].…”

“…At high pH, bile acids may cause gastric and duodenal bulb mucosal damage [ 7 , 8 , 11 , 12 , 15 ]. Previous reports also suggest that bicarbonate in pancreatic secretion contributes to the increase in the pH in the bulb, leading to recurrent duodenal ulcer and deformity [ 12 ]. The presence of pancreatic secretion, in addition to bile, seems to be necessary for the development of deformity, ulcers, and stenosis.…”

Our Surgical Experience in Choledoch Opening Anomalies

“…In the literature, it is reported that 50-95% of cases with ectopic biliary drainage are seen in the male sex. This might bring to mind an etiologic relation with Y chromosome-induced embryonic abnormality (1,3,7,8) . In our series, male gender dominance was present in support of the findings in the literature.…”

“…Ectopic opening of the CBD is commonly associated with biliary tract diseases. Gallstone, choledocholithiasis, obstructive jaundice, cholangitis, pancreatitis and peptic ulcer are complications of ectopic CBD openings (1,2,7,8) . Malfunction of the valve mechanism is blamed for the occurrence of these complications.…”

“…Although congenital anomalies of the common bile duct are more common in childhood, they can also be diagnosed in adulthood. While anomalous opening of the common bile duct in adulthood can be identified incidentally, they can also be diagnosed based on symptoms such as biliary stone, recurrent attacks of cholangitis, duodenal ulcer and/or duodenal obstruction (7) .…”