Cholangiocarcinoma of an Ectopic Outlet of the Main Bile Duct at the Duodeno-Jejunal Angle – A Case Report

Abstract

An ectopic outlet of the common bile duct is a rare congenital disorder of the biliary tract. These abnormalities pose a diagnostic problem, and their clinical presentation is not specific. As patients are usually asymptomatic at early stages, the diagnosis is often incidental and at an advanced stage, when clinical manifestations become noticeable. Imaging tests such as hepatic MRI and CT are essential for positive and differential diagnosis, assessment of extension, and treatment planning. We report a case of a locally advanced tumour in an ectopic biliopancreatic outlet of the main bile duct at the duodenojejunal angle, in a young patient presenting with clinical cholestasis syndrome. The diagnosis was made by an abdominopelvic CT scan and confirmed by Bili-MRI and a biopsy of a liver nodule in the third segment. The biopsy showed metastasis from adenocarcinoma on extemporaneous examination. A double hepatojejunal and gastrojejunal bypass on a Y-shaped loop and a retrograde cholecystectomy with subhepatic redon drainage were performed. The patient’s postoperative course was uneventful. In the presence of congenital anomalies, the surgeon must remain vigilant because of the potential for accidents during the operation.