Duplicated common bile duct detected by hepatobiliary scintigraphy and SPECT/CT

Barashki, S.; Jangjou, A.; Nesari Javan, F.; Roustaei, H.O.; Fakhar, Y.; Sadeghi, R.

doi:10.1016/j.remnie.2020.09.009

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Arrow points to the aberrant drainage pathway." ] ] ] "textoCompleto" => "A 21-year-old woman had a history of multiple traumas with blunt abdominal trauma and rupture of colon and horizontal part (3rd part) of the duodenum following car accident approximately 3 months ago. Because of hemodynamically unstable status she was candidate for delayed restoration of the duodenal rupture. A tube duodenostomy was inserted and feeding jejunostomy was performed during this period. Three months after trauma, she underwent duodenojujenal anastomosis (between jejunum and 2nd part of the duodenum). Due to severe inflammation and adhesions, 3rd part of the duodenum was left in its position without resection. After surgery, biliary discharge was seen from the drainage site of the anastomosis. The patient was suspected of having biliary leakage from the anastomosis area, and underwent a second look surgery, with no problem found at the site of the anastomosis. Ten days later, she was referred to the nuclear medicine department with suspicious bile duct abnormality for hepatobiliary scintigraphy.After IV injection of technetium-99m-mebrofenin scanning was performed dynamically every 1min for 60min and demonstrated normal hepatic uptake. The intrahepatic and extrahepatic ducts were seen normally and normal excretion of the radiotracer into the intestine after 20min was noted. The scan also showed an aberrant drainage of activity from proximal portion of CBD (arrow). Tracer accumulation in the ostomy bag (due to unrepaired previous feeding jejunostomy) was also noted (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>SPECT/CT images were obtained from abdominal region immediately after dynamic images and showed duplicated common bile ducts (DCBD). The aberrant pathway was connected to the residual portion of duodenum behind Treitz ligament after duodenojejunal anastomosis procedure (dotted arrow). Also a stent was noted in the original pathway (arrow head) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Among the different anomalies of the biliary system, duplicated common bile duct is very uncommon.<a class="elsevierStyleCrossRef" href="#bib0020">1</a> The latest classification of DCBD was proposed by Choi et al.<a class="elsevierStyleCrossRef" href="#bib0025">2</a> According to this classification, our case showed a type II DCBD.Biliary scintigraphy is an indispensable tool for biliary tract disease diagnosis.<a class="elsevierStyleCrossRef" href="#bib0030">3</a> Our case shows the importance of biliary scintigraphy and SPECT/CT in localization and detection of aberrant biliary anatomy.Conflict of interestNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "⋆" "nota" => "Please cite this article as: Barashki S, Jangjou A, Javan FN, Roustaei HO, Fakhar Y, Sadeghi R. Conducto biliar común duplicado detectado mediante gammagrafía hepatobiliar y SPECT/CT. Rev Esp Med Nucl Imagen Mol. 2022;41:49–50." ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2349 "Ancho" => 2917 "Tamanyo" => 211546 ] ] "descripcion" => array:1 [ "en" => "Anterior dynamic images of the patient. Arrow points to the aberrant drainage pathway." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1373 "Ancho" => 3417 "Tamanyo" => 499042 ] ] "descripcion" => array:1 [ "en" => "SPECT/CT images of the patient. Duplicated common bile duct is marked by red and dotted arrows. Arrowhead points to the stent in the common bile duct." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Double common bile duct" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D. Teilum" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1055/s-2007-1018360" "Revista" => array:6 [ "tituloSerie" => "Endoscopy" "fecha" => "1986" "volumen" => "18" "paginaInicial" => "159" "paginaFinal" => "161" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3732185" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Duplication of the extrahepatic bile duct with anomalous union of the pancreaticobiliary ductal system revealed by MR cholangiopancreatography" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Choi" 1 => "J. Byun" 2 => "B. Park" 3 => "M.-G. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1259/bjr/50929809" "Revista" => array:6 [ "tituloSerie" => "Br J Radiol" "fecha" => "2007" "volumen" => "80" "paginaInicial" => "e150" "paginaFinal" => "e154" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17704313" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spontaneous perforation of common bile duct in a pediatric patient: application of hepatobiliary scintigraphy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Joodi" 1 => "N. Norouzbeigi" 2 => "M.A. Rad" 3 => "R. Shojaeian" 4 => "V.R. Kakhki" 5 => "R. Sadeghi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/RLU.0b013e318263928f" "Revista" => array:6 [ "tituloSerie" => "Clin Nucl Med" "fecha" => "2012" "volumen" => "37" "paginaInicial" => "1006" "paginaFinal" => "1008" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22955078" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000004100000001/v1_202201040537/S2253808920301130/v1_202201040537/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000004100000001/v1_202201040537/S2253808920301130/v1_202201040537/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808920301130?idApp=UINPBA00004N"]

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The Revista Española de Medicina Nuclear e Imagen Molecular (Spanish Journal of Nuclear Medicine and Molecular Imaging), was founded in 1982, and is the official journal of the Spanish Society of Nuclear Medicine and Molecular Imaging, which has more than 700 members. The Journal, which publishes 6 regular issues per year, has the promotion of research and continuing education in all fields of Nuclear Medicine as its main aim. For this, its principal sections are Originals, Clinical Notes, Images of Interest, and Special Collaboration articles. The works may be submitted in Spanish or English and are subjected to a peer review process. In 2009, it became the leading Spanish journal in the field of Medical Imaging on having an Impact Factor , awarded by the Journal Citation Reports.

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