To raise awareness of benign duodenal strictures as a potential cause of biliary dilation, particularly in the context of anatomical variants, and discuss the necessity of individualized surgical strategies within a multidisciplinary team framework.
Approach:
Case Presentation: A 56-year-old male presented with abdominal pain and a history of duodenal ulcer and nephrectomy. Imaging revealed significant biliary dilation and a double gallbladder anomaly.
Surgical Intervention: After conservative management failed, the patient underwent distal gastrectomy, double cholecystectomy, and choledochotomy with T-tube drainage.
Key Findings:
The patient had chronic biliary obstruction due to a duodenal ulcer-related stricture.
Imaging studies revealed significant dilation of intrahepatic and extrahepatic bile ducts, cholestasis, and gallstone formation, along with a double gallbladder anomaly.
Surgical exploration confirmed a fibrotic duodenal stricture and sludge-filled gallbladders.
Interpretation:
Benign duodenal strictures can lead to chronic biliary obstruction, exacerbated by anatomical variants like a double gallbladder, creating a complex clinical scenario.
Limitations:
The case report is based on a single patient, limiting generalizability.
Long-term outcomes of the surgical intervention are not discussed.
Conclusion:
The report emphasizes the need to consider proximal obstructive lesions, such as duodenal strictures, in unexplained biliary dilation cases, especially when anatomical variants like a double gallbladder are present.
