Anomalous opening of the common bile duct into the duodenal bulb: endoscopic treatment View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2007-07-05

AUTHORS

Selcuk Disibeyaz, Erkan Parlak, Bahattin Cicek, Cem Cengiz, Sedef O Kuran, Dilek Oguz, Hakan Güzel, Burhan Sahin

ABSTRACT

BackgroundAnomalous biliary opening especially the presence of the ampulla of Vater in the duodenal bulb is a very rare phenomenon. We report clinical implications, laboratory and ERCP findings and also therapeutic approaches in 53 cases.MethodsThe data were collected from the records of 12.158 ERCP. The diagnosis was established as an anomalous opening of the common bile duct (CBD) into the duodenal bulb when there is an orifice observed in the bulb with the absence of a papillary structure at its normal localization and when the CBD is visualized by cholangiography through this orifice without evidence of any other opening.ResultsA total of 53 cases were recruited. There was an obvious male preponderance (M/F: 49/4). Demographic data and ERCP findings were available for all, but clinical characteristics and laboratory findings could be obtained from 39 patients with full records. Thirty – seven of 39 cases had abdominal pain (95%) and 23 of them (59%) had cholangitis as well. Elevated AP and GGT were found in 97.4% (52/53). History of cholecystectomy was present in 64% of the cases, recurrent cholangitis in 26% and duodenal ulcer in 45%. Normal papilla was not observed in any of the patients and a cleft-like opening was evident instead. The CBD was hook shaped at the distal part that opens to the duodenal bulb. Pancreatic duct (PD) was opening separately into the bulb in all the cases when it was possible to visualize. Dilated CBD in ERCP was evident in 94% and the CBD stone was demonstrated in 51%. PD was dilated in four of 12 (33%) cases. None of them has a history of pancreatitis. Endoscopically, Papillary Balloon Dilatation instead of Sphincterotomy carried out in 19 of 27 patients (70%) with choledocholithiazis. Remaining eight patients had undergone surgery (30%). Clinical symptoms were resolved with medical treatment in 16(32%) patients with dilated CBD but no stone. Perforation and bleeding were occurred only in two patients, which stones extracted with sphincterotomy (each complication in 1 patient).ConclusionThe opening of the CBD into the duodenal bulb is a rare event that may be associated with biliary and gastric/duodenal diseases. To date, surgical treatment has been preferred. In our experience, sphincterotomy has a high risk since it may lead to bleeding and perforation by virtue of the fact that a true papillary structure is absent. However, we performed balloon dilatation of the orifice successfully without any serious complication and suggest this as a safe therapeutic modality. More... »

PAGES

26

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/1471-230x-7-26

DOI

http://dx.doi.org/10.1186/1471-230x-7-26

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1044675480

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/17610747


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82 high risk
83 history
84 history of cholecystectomy
85 history of pancreatitis
86 hooks
87 implications
88 laboratory
89 laboratory findings
90 localization
91 male preponderance
92 medical treatment
93 modalities
94 normal localization
95 normal papilla
96 opening
97 orifice
98 pain
99 pancreatic duct
100 pancreatitis
101 papillae
102 papillary balloon dilatation
103 papillary structures
104 part
105 patients
106 perforation
107 phenomenon
108 preponderance
109 presence
110 rare event
111 rare phenomenon
112 records
113 recurrent cholangitis
114 risk
115 safe therapeutic modality
116 serious complications
117 sphincterotomy
118 stones
119 structure
120 surgery
121 surgical treatment
122 symptoms
123 therapeutic approaches
124 therapeutic modalities
125 total
126 treatment
127 true papillary structures
128 ulcers
129 virtue
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