Abstract
A 59-year-old woman was referred to our hospital because of barium reflux to the bile duct in the upper gastrointestinal series from an annual medical check-up suggesting gastrocholedocal fistula. Gastrointestinal endoscopy showed a small orifice in the lesser curvature of the middle stomach. MRCP and ERCP delineated an ectopic bile duct bifurcating from the left hepatic duct and a common bile duct with filling defects. We diagnosed double bile duct associated with choledocholithiasis and surgery was performed. In operative findings, an ectopic bile duct lay between the left hepatic duct and lesser curvature of the stomach in the lesser omentum. The other two bile ducts were newly detected in the operation, which joined into the ectopic bile duct. In cholangioscopy, these two had normal mucosa of the bile duct and drained the caudate lobe, and therefore diagnosed as accessory hepatic ducts. We performed a cholecystectomy, choledocholithotomy, and an ectopic and accessory bile duct resection with partial gastrectomy while preserving an accessory hepatic duct near the left hepatic duct. Pathologically, ectopic and accessory hepatic ducts showed a normal wall structure of the bile duct, and no malignancy. Here, we report a rare operative case of double bile duct with an accessory hepatic duct on the left side.
