| 십이지장 구부에 발생한 이소성 총담관 개구의 임상 양상 및 내시경적 치료에 대한 고찰 |
| 임상수ㆍ김홍자ㆍ백두산ㆍ신기철ㆍ송일한ㆍ최용우*ㆍ한정호†ㆍ박상흠‡ |
| 단국대학교 의과대학 내과학교실, *건양대학교 의과대학 내과학교실, †청주성모병원 내과, ‡순천향대학교 의과대학 천안병원 내과학교실 |
| An Ectopic Opening of the Common Bile Duct into the Duodenal Bulb: The Clinical Features and Endoscopic Treatment |
| Sang Soo Lim, M.D., Hong Ja Kim, M.D., Du San Baik, M.D., Ki Chul Shin, M.D., Il Han Song, M.D., Young Woo Choi, M.D.*, Jung Ho Han, M.D.† and Sang Heum Park, M.D.‡ |
| Department of Internal Medicine, Dankook University College of Medicine, Cheonan, *Konyang University College of Medicine, Daejeon, †Cheongju St. Mary's Hospital, Cheongju, ‡Soonchunhyang University College of Medine, Soonchunhyang University Hospital, Cheonan, Korea |
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| Abstract |
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Background/Aims:
An ectopic opening of the common bile duct (CBD) into the duodenal bulb is known to cause biliary tract diseases or peptic ulcer. Yet such a case is extremely rare and the clinical significance of this malformation has not yet been clarified.
Methods:
Ten patients with an ectopic opening in the duodenal bulb and who were treated at 4 hospitals in the Chungcheong province area were enrolled. Their clinical and radiographic features and the treatment for their combined biliary diseases were retrospectively analysed.
Results:
The mean age of the ten patients was 73 years (range: 38∼84 years, 8 men, 2 women) Eight of 10 patients had clinical signs and symptoms (RUQ abdominal pain: 5, epigastric pain: 3, fever: 3, Melena: 1). The two patients without symptoms were incidentally found to have an ectopic orifice during the evaluation for bile duct dilatation and a regular health check-up, respectively. Nine had duodenal ulcer scars or bulb deformities. Four had active duodenal ulcers and one of them had bleeding from the active duodenal ulcer, which was treated by endoscopic sclerotheraphy. Six of the 10 patients (60%) had biliary tract diseases (CBD stones: 4, cholangitis without CBD stone: 1, IHD stone: 1). Cholangiography was used for evaluation in 9 patients, and it showed dilatation of the CBD or IHD in 7 (78%), a tapered common bile duct at the distal CBD in 7 (78%) and a hook-shaped distal CBD in 8 (89%). Six patients' biliary tract diseases were treated endoscopically (ERCP: 4, PTCS: 2). Duodenal perforation occurred in 1 (10%), who was successfully managed by medical treatment.
Conclusions:
An ectopic opening of the CBD in the duodenal bulb is frequently associated with recurrent duodenal ulcer and biliary tract disease. Combined biliary tract disease can be successfully treated endoscopically. (Korean J Gastrointest Endosc 2010;40:16-21) |
| Key Words:
Ectopic opening of common bile duct, Biliary tract disease, Duodenal ulcer |
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