Brunner’s gland hamartoma: a cause of the double-duct sign

Introduction Brunner’s glands are submucosal glands found in the duodenum. Proliferation of these glands can lead to the formation of Brunner’s gland hamartomas (BGHs), which are uncommon, asymptomatic and usually found incidentally. They are predominantly benign lesions, but instances of malignant transformation have been reported. Case History We describe a rare case in which a periampullary lesion was causing biliary obstruction on a background of weight loss, and was associated with dilatation of the common bile duct and pancreatic duct on computed tomography and magnetic resonance imaging. Further investigation with endoscopic ultrasound and biopsy did not provide a definitive diagnosis. Given the symptoms and findings upon investigations, we proceeded to pylorus-preserving pancreatoduodenectomy. Conclusions This was a rare case in which BGH gave rise to biliary obstruction against a background of weight loss. Due to a high index of suspicion (weight loss and evidence of dilatation of the common bile duct and pancreatic duct), this procedure was justified because the consequences of a missed periampullary cancer far outweighed surgical risks.

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Duodenal peripapillary adenocarcinoma causing extrahepatic biliary obstruction and icterus in a cat

Vlaams Diergeneeskundig Tijdschrift ◽

10.21825/vdt.v89i5.16954 ◽

2020 ◽

Vol 89 (5) ◽

pp. 273-277

Author(s):

T. Rick ◽

E. Stock ◽

I. Van de Maele ◽

E. Kammergruber ◽

J. Saunders

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Biliary Obstruction ◽

Ultrasound Examination ◽

Duodenal Wall ◽

Abdominal Ultrasonography ◽

Extrahepatic Biliary Obstruction ◽

History Of ◽

The Common ◽

Distal Aspect

A six-year-old, female, neutered domestic shorthair cat was presented with chronic weight loss and a two-day history of partial anorexia and lethargy. Abdominal ultrasonography revealed a regional thickening of the duodenal wall with loss of normal layering, a normally walled segmentally dilated distal aspect of the common bile duct containing slightly hyperechoic bile, and a mild to moderately enlarged major duodenal papilla. Based on the ultrasound examination, the primary differential diagnosis was a peripapillary duodenal neoplastic or less likely, an inflammatory or infectious process with secondary extrahepatic biliary obstruction. Postmortem examination revealed a duodenal, peripapillary adenocarcinoma with metastasis into the liver and lymph nodes, and external compressive obstruction of cystic- and common bile duct.

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Endoscopic retrograde cholangio-pancreatography: a review for endoscopy nurses and assistants

Gastrointestinal Nursing ◽

10.12968/gasn.2019.17.sup8.s8 ◽

2019 ◽

Vol 17 (Sup8) ◽

pp. S8-S14

Author(s):

Muhammad Waqas Fazal ◽

Maria Tan ◽

Shyam Menon

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Pancreatic Duct ◽

Clinical Outcomes ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Patient Selection ◽

Basic Knowledge ◽

Endoscopic Retrograde ◽

The Common

Endoscopic retrograde cholangiopancreatography (ERCP) facilitates endoscopic access to the common bile duct and pancreatic duct. It has become central to the management of a variety of benign and malignant pancreatobiliary disorders. ERCP remains a technically challenging procedure and patient selection and pre-assessment is critical to ensure good clinical outcomes. Staff assisting in ERCP should familiarise themselves with the underlying principles and basic knowledge pertaining to various aspects of ERCP.

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Metastatic melanoma presenting as malignant biliary obstruction of the common bile duct demonstrated with single-operator digital cholangioscopy

VideoGIE ◽

10.1016/j.vgie.2017.05.008 ◽

2017 ◽

Vol 2 (10) ◽

pp. 266-267

Author(s):

Prapimphan Aumpansub ◽

Phonthep Angsuwatcharakon ◽

Naruemon Wisedopas ◽

Wiriyaporn Ridtitid ◽

Rungsun Rerknimitr

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Metastatic Melanoma ◽

Biliary Obstruction ◽

Malignant Biliary Obstruction ◽

Single Operator ◽

The Common

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THE TERMINAL PORTION OF THE COMMON BILE DUCT AND OF THE PANCREATIC DUCT OF WIRSUNG

ANZ Journal of Surgery ◽

10.1111/j.1445-2197.1954.tb05048.x ◽

1954 ◽

Vol 23 (3) ◽

pp. 223-235 ◽

Cited By ~ 16

Author(s):

E. S. R. Hughes ◽

R. H. Kernutt

Keyword(s):

Bile Duct ◽

Common Bile Duct ◽

Pancreatic Duct ◽

Terminal Portion ◽

The Common

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Dilation of Both Pancreatic Duct and the Common Bile Duct on Computed Tomography and Magnetic Resonance Imaging Scans in Patients With or Without Obstructive Jaundice

Pancreas ◽

10.1097/mpa.0b013e31823ba536 ◽

2012 ◽

pp. 1

Author(s):

Naveen Krishna ◽

Pavan Tummala ◽

Amith V. Reddy ◽

Mohit Mehra ◽

Banke Agarwal

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Bile Duct ◽

Magnetic Resonance ◽

Common Bile Duct ◽

Obstructive Jaundice ◽

Pancreatic Duct ◽

Resonance Imaging ◽

The Common

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Measurement of the Diameter of the Common Bile Duct and Pancreatic Duct among Healthy Adult Sudanese Subjects using Magnetic Resonance Cholangiopancreatography

International Journal of Biomedicine ◽

10.21103/article10(4)_oa12 ◽

2020 ◽

Vol 10 (4) ◽

pp. 392-396

Author(s):

Rani Abu Elgasim ◽

Ahmed Abukonna ◽

Ala Elgyoum ◽

Mogahid Zidan ◽

Mustafa Mahmoud ◽

...

Keyword(s):

Bile Duct ◽

Magnetic Resonance ◽

Common Bile Duct ◽

Pancreatic Duct ◽

Healthy Adult ◽

Body Height ◽

Biliary Tract Disease ◽

Magnetic Resonance Cholangiopancreatography ◽

The Common ◽

The Mean

The purpose of our study was to evaluate the common bile duct (CBD) and pancreatic duct (PD) diameter among healthy adult Sudanese subjects using magnetic resonance cholangiopancreatography (MRCP). In addition, this study aimed to determine the effects of age, gender, and body height and weight on the CBD and PD diameters to establish a reference range for these ducts on MRCP, which is very useful in a daily clinical setting where MRCP is commonly performed to evaluate suspected biliary tract disease. Methods and Results: This study included 80 asymptomatic subjects who underwent MRCP. The widest diameter of the CBD and PD was measured perpendicular to their long axes using the electronic caliper. The applied MRCP imaging technique was in line with the guidelines used by Chen et al.(2012) The age, gender, medical history, body height and body weight were recorded. Among the 80 subjects, the mean CBD diameter on MRCP was 6.17±0.69 mm (range of 4-8 mm). There was a significant correlation between the CBD diameter and weight (r=0.407, P<0.001). The mean PD diameter on MRCP was 3.80±0.50mm (range of 2-5 mm). There was also a significant correlation between the PD diameter and weight (r=0.407, P<0.001). In the cohort of 80 subjects, the mean CBD diameter in females was larger than in males(6.50±0.632mm and 5.95±0.677mm, respectively), and this difference was statistically significant (P<0.05). Also, the mean PD diameter in females was statistically larger than in males (6.03±0.66mm and 5.58±0.675mm, respectively), and this difference was statistically significant (P<0.05). Our results demonstrate no significant correlation between the diameter of CBD and PD and participants' height and age. Conclusion: The importance of the current study lies in it’s being one of the few studies whose intention was to use MRCP to bridge the knowledge gap in the literature about the measurement of the CBD and PD diameter among healthy adult Sudanese subjects.

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