Retrospective analysis of cases with an ectopic opening of the common bile duct into duodenal bulb.

BACKGROUND: Ectopic opening of the common bile duct (EOCBD) is a very rare entity. It has been reported in the 3rd or 4th portion of the duodenum, pyloric canal, duodenal bulb, and the stomach.

OBJECTIVES: The aim of this study was to evaluate the clinical characteristics, laboratory values and imaging studies of patients with EOCBD into the duodenal bulb retrospectively.

MATERIAL AND METHODS: The files of patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2003 and November 2015 were reviewed. The demographic data, presentations, abdominal ultrasonography, computed tomography (CT), magnetic resonance cholangiopancreatography (MRCP), and ERCP findings of patients with EOCBD into the duodenal bulb were evaluated retrospectively.

RESULTS: Ectopic openings of the CBD into the duodenal bulb were found in 20 out of 3,270 patients who had undergone ERCP. Twenty patients (15 males and 5 females) with a median age of 59 (40-88) years were included in the study. Ectopic opening of the CBD into the duodenal bulb were found in 20 patients (0.61%). Laboratory test abnormalities included: hyperbilirubinemia in 20 (100%) patients, leukocytosis in 14 (70%) patients, an elevated serum alkaline phosphatase and gamma-glutamyl transferase level in 20 (100%) patients. Indications for ERCP were CBD dilatation and extrahepatic cholestasis (n = 20), cholangitis (n = 12), only choledocholithiasis (n = 7), and acute pancreatitis (n = 2).

CONCLUSIONS: In patients with recurrent duodenal ulcers and/or apical stricture with accompanying CBD dilatation, extrahepatic cholestasis and cholangitis, EOCBD into the duodenal bulb should be considered.