Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male wa...Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.展开更多
BACKGROUND Ectopic opening of the common bile duct is a condition with low incidence.Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis.Patients wi...BACKGROUND Ectopic opening of the common bile duct is a condition with low incidence.Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis.Patients with atypical symptoms and imaging findings are easily misdiagnosed;moreover,it is difficult to retrieve stones by endoscopic retrograde cholangiopancreatography,and common bile duct stones are prone to postsurgical recurrence.CASE SUMMARY A 45-year-old male patient presented with“intermittent upper abdominal pain and elevated liver enzymes for 1 wk”.Transabdominal ultrasound indicated dilation of the common bile duct and the presence of stones.Magnetic resonance imaging showed that the common bile duct was dilated with stones and that its opening was ectopic.Endoscopic retrograde cholangiopancreatography revealed an abnormal opening of the common bile duct into the duodenal bulb and the presence of common bile duct stones.Laparoscopic extrahepatic choledochectomy and hepatoenteric anastomosis were performed.After surgery,the patient recovered well and was discharged.The patient has been followed up for 2 years since the operation.He has not experienced stone recurrence,and his liver function and quality of life are good.CONCLUSION Improved understanding of ectopic opening of the common bile duct is needed for clinicians to provide patients with appropriate treatment.展开更多
Ectopic seminal tract openi ng is a rare con genital malformation.Until rece ntly,there has been a lack of comprehensive reporting on the condition.The purpose of this retrospective study is to summarize the experienc...Ectopic seminal tract openi ng is a rare con genital malformation.Until rece ntly,there has been a lack of comprehensive reporting on the condition.The purpose of this retrospective study is to summarize the experience of diagnosis and treatment of this condition based on 28 clinical practice cases throughout the past 30 years.We conducted auxiliary examinations on such patients including routine tests,imaging examinations,and endoscopy.Among these 28 cases,there were ectopic opening of vas deferens into enlarged prostatic utricles(6 cases);ejaculatory ducts into enlarged prostatic utricles,Mullerian ducts cysts,and urethras(18 cases,2 cases,and 1 case,respectively);and ectopic opening of the unilateral vas deferens and the contralateral ejaculatory duct into enlarged prostatic utricle(1 case).The size of the enlarged prostatic utricle,the type of ectopic seminal tract opening,and the opening's location effectively assisted in the selection of clinical treatment methods,including transurethral fenestration of the utricle,transurethral cold-knife incision,open operation,laparoscopic operation,and conservative treatment.Satisfactory effect was achieved during follow-up.In conclusion,a definite diagnosis and personalized treatment are especially important for patients with ectopic seminal tract opening.展开更多
文摘Among the various congenital anomalies of the biliary system,an ectopic opening of the common bile duct (CBD) in the duodenal bulb is extremely rare. ERCP is essential for diagnosing the anomaly. A 55-year-old male was admitted to hospital for severe right upper quadrant abdominal pain,followed by fever, chills, elevated body temperature and mild icterus. The diagnosis of ectopic opening of CBD in the duodenal bulb was established on endoscopic ultraso-nography (EUS),which clearly demonstrated dilated CBD, with multiple stones and air in the lumen, draining into the bulb. A normal pancreatic duct, which did not drain into the bulb, was also observed. This finding was confirmed on ERCP and surgery.As far as we know, this is the first case of this anomaly diagnosed by EUS. Ectopic opening of the CBD in the duodenal bulb is not an incidental finding, but a pathologic condition which can be associated with clinical entities such as recurrent or intractable duodenal ulcer, recurrent biliary pain,choledocholithiasis or acute cholangitis. Endoscopic ultrasonography features allow preoperative diagnosis of this anomaly and can replace ERCP as a first diagnostic tool in such clinical circumstances. Embryology of the anomalies of the extrahepatic biliary tree has been also reviewed.
基金Supported by The Key Research and Development Program of Gansu,No. 17YF1FA128Lanzhou Science and Technology Bureau Innovation and Entrepreneurship Talent Program,No. 2017-RC-37.
文摘BACKGROUND Ectopic opening of the common bile duct is a condition with low incidence.Patients with an ectopic common bile duct opening have a high incidence of common bile duct stones and acute cholangitis.Patients with atypical symptoms and imaging findings are easily misdiagnosed;moreover,it is difficult to retrieve stones by endoscopic retrograde cholangiopancreatography,and common bile duct stones are prone to postsurgical recurrence.CASE SUMMARY A 45-year-old male patient presented with“intermittent upper abdominal pain and elevated liver enzymes for 1 wk”.Transabdominal ultrasound indicated dilation of the common bile duct and the presence of stones.Magnetic resonance imaging showed that the common bile duct was dilated with stones and that its opening was ectopic.Endoscopic retrograde cholangiopancreatography revealed an abnormal opening of the common bile duct into the duodenal bulb and the presence of common bile duct stones.Laparoscopic extrahepatic choledochectomy and hepatoenteric anastomosis were performed.After surgery,the patient recovered well and was discharged.The patient has been followed up for 2 years since the operation.He has not experienced stone recurrence,and his liver function and quality of life are good.CONCLUSION Improved understanding of ectopic opening of the common bile duct is needed for clinicians to provide patients with appropriate treatment.
文摘Ectopic seminal tract openi ng is a rare con genital malformation.Until rece ntly,there has been a lack of comprehensive reporting on the condition.The purpose of this retrospective study is to summarize the experience of diagnosis and treatment of this condition based on 28 clinical practice cases throughout the past 30 years.We conducted auxiliary examinations on such patients including routine tests,imaging examinations,and endoscopy.Among these 28 cases,there were ectopic opening of vas deferens into enlarged prostatic utricles(6 cases);ejaculatory ducts into enlarged prostatic utricles,Mullerian ducts cysts,and urethras(18 cases,2 cases,and 1 case,respectively);and ectopic opening of the unilateral vas deferens and the contralateral ejaculatory duct into enlarged prostatic utricle(1 case).The size of the enlarged prostatic utricle,the type of ectopic seminal tract opening,and the opening's location effectively assisted in the selection of clinical treatment methods,including transurethral fenestration of the utricle,transurethral cold-knife incision,open operation,laparoscopic operation,and conservative treatment.Satisfactory effect was achieved during follow-up.In conclusion,a definite diagnosis and personalized treatment are especially important for patients with ectopic seminal tract opening.
