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A case of double common bile duct visually detected only by cholangioscope
Double common bile duct is a rare congenital anomaly   . We report a case of a 53-year-old Japanese man who was incidentally diagnosed with a double common bile duct by cholangioscope examination. He developed mild acute cholecystitis and received antibiotics. Drip-infusion cholangiography-computed tomography demonstrated a filling defect in the common bile duct (CBD) ([Fig. 1 a]). Endoscopic retrograde cholangiography (ERC) showed a normal bile duct image ([Fig. 1 b]), and the patient was diagnosed with spontaneous passage of choledocholithiasis. However, bile cytology detected atypical cells and this patient was referred to our facility.
Contrast-enhanced endoscopic ultrasound showed no contrast echoic lesions in the cystic duct and gallbladder, and sludge was suspected, but the CBD was normal ([Fig. 1 c – e]). We performed cholangioscopy (SpyGlass-DSII; Boston Scientific, Marlborough, Massachusetts, USA) to rule out minimal biliary cancer because previous cytology suggested possible malignancy. The cholangioscopy incidentally showed a common bile duct divided into two lumens ([Video 1]). We inserted a guidewire from the contralateral lumen and visually recognized the crossed guidewire from the alternative lumen, which was evidence for a double common bile duct ([Fig. 2 a – c]). The cystic duct branched from one lumen of the double CBD. The cholangioscopy did not show any tumor, and biopsy specimens and bile cytology were negative for malignancy.
Video 1 A case of double common bile duct visually detected only by cholangioscope.
This case is a type I double common bile duct according to Saito’s classification . There had previously been only one report of a double common bile duct visualized on cholangioscopy by Kawakubo , but this is the first report of a double common bile duct without ectopic drainage of the bile duct. Surprisingly, no modality other than the cholangioscope could detect the double common bile duct. This finding indicates that type I cases might be more latent and prevalent. We hope that a greater number of cases will elucidate the epidemiology of the double common bile duct in future.
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04 February 2021 (online)
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