Preduodenal position of the common bile duct associated with annular pancreas: case report and literature review.

A preduodenal position of the common bile duct (PDCBD) is a very rare embryological anomaly. Our patient, a 1-day-old boy, was diagnosed to have PDCBD, annular pancreas, duodenal stenosis, intestinal malrotation and a ventricular septal defect associated with 21 trisomy. Initially the fetal diagnosis was duodenal atresia. The diagnosis of duodenal stenosis was made on birth, and he underwent an emergency operation 24 hours later. The PDCBD was discovered during the duodenoduodenostomy procedure. While a transversal incision was being made for the ventral wall in the distended proximal duodenum, the common bile duct was accidentally cut. We found the common bile duct to run into the ventral side of the duodenal wall. Subsequently, the common bile duct was repaired with a stent using microscopic techniques. The case is being reported because of the rarity of this condition and also to stress the importance of accurately recognizing this anomaly when treating the concomitant diseases, particularly when surgical implications are involved.