Celiac Disease - Duodenal Mucosa (5 of 5)

Small hole of which bile emerges at anterior wall of duodenal bulb. The GI tract is an extremely rare congenital anomaly. The clinical implications and frequency of this anomaly are not clearly known. Although an ectopic opening of the CBD is rare, it may be associated with severe pancreaticobiliary disorders. Endoscopists should be aware of this anomaly and know what to do in case they encounter the condition. Small hole of which bile emerges at anterior wall of duodenal bulb. An ectopic opening of the common bile duct in the duodenal bulb is an extremely rare anomaly and one that should not be dismissed as just a benign congenital variant because it is associated with recurrent duodenal ulcer, biliary pain, choledocholithiasis, and recurrent cholangitis. Caution must be exercised before diagnosing such ectopia because duodenal ulcer also can cause a choledochoduodenal fistula. To make the diagnosis of ectopic common bile duct, there must be no evidence of a papillary structure in the lower duodenum. A good history, thoughtful endoscopy, and good pancreaticobiliary imaging is key to proper diagnosis.