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Duplication of extrahepatic bile duct with lower common bile duct cancer

A 90-year-old female who previously underwent a cholecystectomy for a gallbladder stone was admitted to our hospital with jaundice. Magnetic resonance cholangiopancreatography (MRCP) revealed left and right bile ducts parallel with the duodenal papilla, and joined distally to form a single short common bile duct with no pancreaticobiliary maljunction (Figure 1). The remnant cystic duct diverged from the right hepatic duct without a common hepatic duct. Endoscopic ultrasound revealed the lower common bile duct as stenotic due to a 6-mm tumor. Based on results of bile duct brush cytology during endoscopic retrograde cholangiopancreatography (ERCP), the diagnosis was lower bile duct carcinoma.