Jamry Andrzej
Background: Physiologically, the common bile duct (CBD) turns to the right as it descends towards the duodenum. The degree of angulation in this turn is dependent on the position of the patient, liver mobility and points that stabilize the CBD, such as postoperative adhesions. In extreme cases, the sharpness of this angulation can by induce jaundice and recurrent choledocholithiasis. In this report, the authors describe a woman for whom pathological angulation occurs only in a sitting position. In view of periodic appearance of symptoms to establish the correct diagnosis it is difficult, therefore we proposed a method of enabling confirmation of the existence of this unusual pathology. In the available publications we not found a similar description of the disease and methods for its diagnosis.
Case presentation: The paper presents the a 55-year-old woman with recurrent pain in the right upper quadrant with comorbid jaundice most often after a long journey by car. In the past patient underwent classical cholecystectomy with revision of the CBD and endoscopic sphincterotomy. Despite this treatment, symptoms continued to recur. On that basis, we decided examine her biliary tree in a sitting position using for this purpose nasobiliary tube (NBT). The image acquired in this way revealed the presence of a pathological CBD angulation, which explained the symptoms.
Conclusion: Bending to the bile duct is rare and difficult to diagnose cause transient jaundice. However, in some cases where the clinical picture points to the cause, cholangiography using the NBT can be the basis to determine the correct diagnosis.