Duplication of the Extrahepatic Bile Duct in Association with Choledocholithiasis as Depicted by MDCT

Duplication of the Extrahepatic Bile Duct in Association with Choledocholithiasis as Depicted by MDCTWe report here on an extremely rare case of duplicated extrahepatic bile ducts that was associated with choledocholithiasis, and this malady was visualized by employing the minimum intensity projection images with using multi-detector row CT.The presence of duplicated extrahepatic bile ducts with a proximal communication, and the ducts were joined distally and they subsequently formed a single common bile duct, has not been previously reported.ongenital duplication of the extrahepatic bile duct is a very rare anomaly and this has been reported in only 24 cases in the clinical literature during the last 500 years until 1986 (1).Recognition of this anomaly is clinically important as it can lead to complications such as choledocholithiasis, cholangitis, pancreatitis and upper gastrointestinal malignancies (2).In addition, this anomaly is often accompanied with anomalous union of the pancreaticobiliary ductal system (AUPBD) and the presence of a choledocal cyst (2).Most cases of duplicated extrahepatic bile ducts that have been reported up to now were diagnosed based on the abnormalities that were found by endoscopic retrograde cholangiography (ERC), MR cholangiopancreatography (MRCP) or operative cholangiography (1-8).We present here a case of an adult patient who had duplication of the extrahepatic bile duct along with choledocholithiasis, as was revealed by the minimum intensity projection (MinIP) images of multi-detector row CT (MDCT).To the best of our knowledge, this is the first reported case of the Vb type, according to the modified classification of duplication of the common bile duct (CBD) as proposed by Choi et al. (5). CASE REPORTAn 81-year-old woman presented with a 2-day history of chills and fever.She had been admitted two years ago with jaundice and fever.On a CT scan, the distal CBD, a large gallbladder (GB) and cystic duct stones were revealed.Urgent endoscopic retrograde cholangiopancreatography (ERCP) to remove the distal CBD stone was performed.Multiple CBD stones were extracted using a basket and balloon sweep.After the stones were removed, there was no filling defect on the CBD during balloon cholangiography.The patient refused cholecystectomy.She was not followed up after discharge from the hospital.On the next presentation, the laboratory tests revealed a slightly elevated aspartate aminotransferase level (45 IU/L) and an increased value of C-reactive protein (15.3 mg/I).