A new variant of bile duct duplication with coexistence of distal cholangiocarcinoma.

BACKGROUND

A 72-year-old hypertensive woman presented with a 2-month history of right upper quadrant abdominal pain. She had a 15-day history of jaundice, fever with chills and shivering, nausea, vomiting, weight loss and generalized pruritus.

INVESTIGATIONS: Physical examination, laboratory evaluation, transabdominal ultrasonography, magnetic resonance cholangiopancreatography, endoscopic retrograde cholangiopancreatography, brush cytology, laparotomy and histopathology.

DIAGNOSIS: Bile duct duplication with coexistence of distal cholangiocarcinoma.

MANAGEMENT: En bloc resection (including the duodenum, pancreatic head and adjacent lymph nodes), hepaticojejunostomy and pylorus-saving Whipple operation.