Ectopic bile duct: A case report and brief review

Abstract

Introduction: An ectopic bile duct is the confluence of common bile duct (CBD) and main pancreatic duct away from its usual location in the posteromedial wall of the second part of duodenum. This increases risk of choledocholithiasis and pancreatitis, while proximal locations increase risk of duodenal ulceration and stenosis. Case Report: A woman in her late forties was consented to elective laparoscopic cholecystectomy for symptoms of biliary colic and ultrasonographic features of a mobile gallstone. Intraoperative cholangiogram noted dilated biliary tree and main pancreatic duct despite normal liver function values, as well as an ectopic ampulla of Vater to distal third part of duodenum or proximal fourth part of duodenum. The distal bile duct had a longer common channel. The operation was otherwise uncomplicated. Magnetic resonance cholangiopancreatography demonstrated similar findings. The patient recovered uneventfully and was discharged from surgical services. Conclusion: The gold standard for diagnosing ectopic bile ducts is via endoscopic retrograde cholangiopancreatography. Hepatobiliary anatomical variants can also occur in the location of the ampulla, thus it is important for surgeons and trainees to interpret and document this carefully during intraoperative cholangiogram, especially in patients who may require endoscopic retrograde cholangiopancreatography in the perioperative period and/or later date. The patient should be educated on the associated risks and red flags to seek medical attention.