Right posterior branch draining into intra-pancreatic common duct: the triple duct sign (original) (raw)
Related papers
An unusual cause of simultaneous common bile and pancreatic duct dilation
Gastroenterology report, 2014
Simultaneous dilation of both the common bile duct and the pancreatic duct (double-duct sign) is usually because of ampullary or pancreatic tumours. Here we report an unusual cause of double-duct dilation; we describe the case of a 49-year-old female who developed afferent loop syndrome after pylorus-preserving pancreaticoduodenectomy: crosssectional imaging of the abdomen revealed a double-duct sign.
Hellenic Journal of Surgery, 2019
Duplication of the common bile duct (CBD) is an uncommon congenital anomaly of the extrahepatic biliary tree; less than 150 cases have been reported to date. The anomaly is characterized by the presence of two ducts-usually one main common bile duct and an accessory bile duct. We present one such case in a 7-year-old girl, where the proximal CBD divided into two separate channels for a short distance and reunited distally to open as a common channel into the second part of duodenum. The main pancreatic duct opened proximally into the medial limb of the anomalous CBD, forming an abnormal pancreatico-bile duct junction (APBDJ). According to the accepted classification, this is a Type Va CBD duplication. The patient also had cholelithiasis and calculi in the medial limb and distal common channel. Endoscopic retrograde cholangiopancreatography (ERCP) was performed, with removal of the gallstones, followed by laparoscopic cholecystectomy. Preoperative radiological imaging, such as ERCP and magnetic resonance cholangiopancreatography (MRCP) are strongly recommended for diagnosis of this condition. Surgery may not be needed for all patients and should be tailored to suit each individual case. This case is presented for its rarity, in the hope that it will contribute to the literature coverage.
Cureus, 2021
Synchronous malignancies involving the gallbladder and the bile duct are exceedingly rare. Moreover, their association with anomalous pancreaticobiliary duct junction (APBDJ) has been reported mostly from the Far Eastern countries. Over time, many studies have suggested the definite risk of malignancy attributable to the 'carcinogenic anatomical configuration' of the long common biliopancreatic channel, allowing reflux of pancreatic juices in the biliary tract. In this report, we present a case of an elderly man from South India who was initially diagnosed with synchronous gall bladder with bile duct malignancy; the patient turned out to have an APBDJ on further evaluation.
Indian Journal of Gastroenterology, 2016
Background Knowledge about anatomic variations in intrahepatic biliary ducts (IHBD) is relevant for performing biliary drainage and for avoiding bile duct injury during cholecystectomy and liver resections. Low insertion of cystic duct (LICD) is a common anatomic variant. Pancreas divisum is the commonest congenital anomaly of pancreas; it has been causally linked with recurrent acute pancreatitis (RAP). Methods Magnetic resonance cholangiopancreaticography (MRCP) images of 500 consecutive patients were reviewed for anatomic variants of IHBD, cystic duct, and pancreatic duct. Results Anatomy of IHBD could be evaluated in 458 MRCP's, of these 301 (65.72 %) had 'typical' anatomy. The variant in 157 persons included 'triple confluence' in 56 (12.23 %), 'right posterior segmental duct (RPSD) draining to left hepatic duct (LHD)' in 64 (14 %), 'RPSD to common hepatic duct (CHD)' in 20 (4.4 %), 'RPSD to cystic duct' in 2 (0.4 %), 'accessory duct to CHD' in 3 (0.7 %), 'accessory duct to right hepatic duct (RHD)' in 1 (0.2 %), 'segment 2 and 3 separately to CHD' in 1 (0.2 %), and complex variants in 10 (2.2 %). Cystic duct could be evaluated in 338 patients; of these, 15 (4.4 %) had LICD. Patients with RAP had pancreas divisum more often than those without any pancreatic disease, (−/−,10 % and −/−, 0.8 %; p = 0.004). Conclusions Nearly one third of MRCPs showed atypical IHBD pattern with RPSD draining to LHD being the commonest. LICD was the most common cystic duct variant. Pancreas divisum was more frequent in patients with RAP than in persons without pancreatic disease.
Clinical Journal of Gastroenterology, 2009
A 35-year-old man, a chronic alcohol consumer with clinical features of acute pancreatitis, presented with obstructive jaundice and melena. On radiological evaluation two large pseudocysts, one each in relation to pancreatic head and tail regions, were noted with a gastroduodenal artery pseudoaneurysm in the pseudocyst in the head region. He also had narrowing of the common bile duct. On endoscopic retrograde cholangiopancreatography (ERCP) he had evidence of chronic pancreatitis with morphology of pancreas divisum with disruption of both the dorsal and ventral ducts. After the relieving of bile duct obstruction with endoscopically placed stent, he underwent surgery for the pseudoaneurysm and the two pseudocysts. The case highlights the rare occurrence of both dorsal and ventral ductal disruption in a patient with pancreas divisum. ERCP was helpful in providing the diagnosis and guiding further management.
World Journal of …, 2007
AIM: To study the patients with main pancreatic duct dilation on computed tomography (CT) and thereby to provide the predictive criteria to identify patients at high risk of significant diseases, such as pancreatic cancer, and to avoid unnecessary work up for patients at low risk of such diseases. METHODS: Patients with dilation of the main pancreatic duct on CT at Emory University Hospital in 2002 were identified by computer search. Clinical course and ultimate diagnosis were obtained in all the identified patients by abstraction of their computer database records. CONCLUSION: Patients with pancreatic double duct dilation need extensive work up and careful followup since a majority of these patients are ultimately diagnosed with pancreatic cancer. Patients with single duct dilation, especially such patients without any evidence of chronic pancreatitis, also need careful follow-up since the possibility of pancreatic malignancy, including adenocarcinoma and intraductal papillary mucinous tumors, is still high.
Pancreas, 2010
Anomalous pancreaticobiliary junction is an unusual variant of pancreaticobiliary anatomy of clinical importance because it is associated with increased risk of pancreatitis and, also, for the development of cholangiocarcinoma. We report an unusual variant of anomalous pancreaticobiliary junction, occurring in a patient with pancreas divisum, with an anomalous communication between the dorsal pancreatic and the common bile duct. The patient presented with a distal biliary stricture. This variant anatomy was occult on magnetic resonance cholangiopancreatography but was diagnosed on magnetic resonance cholangiopancreatography that was performed with intravenous secretin administration and further delineated by endoscopic retrograde cholangiopancreatography. The features that allowed the diagnosis to be made and the implications of this diagnosis are described in this report.
Heterotopic Pancreatic Tissue in the Cystic Duct: Complicating Factor or Coexisting Pathology
Southern Medical Journal, 2010
The case of a 75-year-old female suffering from recurrent abdominal pain and nausea is presented. Ultrasound showed gallstones without inflammation of the gallbladder. The patient underwent laparoscopic cholecystectomy and her symptoms resolved. Histological examination of the operation specimen disclosed heterotopic pancreatic tissue within the cystic duct. An accurate clinical diagnosis of pancreatic heterotopia is difficult. The deep submucosal or intramural location of the lesion may hamper retrieval of representative biopsy material. Indications for surgery or endoscopic resection include symptomatic lesions as well as cases of unclear histological examination in order to distinguish pancreatic heterotopia from other tumors.
A Review of Double Common Bile Duct and Its Sequelae
Gastroenterology Research, 2018
A double or accessory common bile duct (ACBD) is a rare congenital anomaly. We report the case of a 60-year-old American Asian male, who was found to have a double or duplicated common bile duct after being admitted for evaluation of a pancreatic mass. A duplicated bile duct has the same mucosa histologically as a single bile duct. However, the opening of a duplicated bile duct lacks a sphincter allowing retrograde flow of gut contents which results in a higher probability of intraductal calculus formation. On rare occasions, it can predispose to liver abscesses, pancreatitis, pancreatic cancer, gallbladder cancer, gastric cancer, and ampullary cancer depending on the location of the opening of the ACBD. We present an integrative review of the limited cases of ACBD with correlation to the current case and discussion regarding the aspects of diagnosis and management.