title: Double-duct sign: do not forget the gallstones.
abstract: A double-duct sign is the combined dilatation of the common bile duct and pancreatic duct, often caused by cancer of the pancreas. We present a patient with colicky pain in the right upper quadrant of her abdomen. On radiological imaging and endosonography, she had a double-duct sign due to choledocholithiasis and no mass in the pancreatic head. A literature search was performed, which indicated that in selected patients with a higher likelihood of pancreas cancer (for example jaundice or pancreatic mass on radiological imaging) up to 85% of patients do indeed have a pancreatic cancer. In an unselected population, regardless of presenting symptoms, a double-duct sign on endoscopic retrograde cholangiopancreatography (ERCP) was caused by a pancreas malignancy in 58% of patients. In selected patients without jaundice but with a double duct sign, pancreas cancer was only seen in 6% of patients. The sensitivity and specificity of the double-duct sign observed by ERCP for pancreatic cancer varies between 50-76% and 63-80%, respectively. Our patient with symptomatic choledocholithiasis underwent an uncomplicated ERCP with stone extraction and papillotomy and was referred for a cholecystectomy.
authors.affiliation: Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam The Netherlands; Email:l.oterdoom@vumc.nl.
authors.forename: Leendert H
authors.initials: LH
authors.lastname: Oterdoom
authors.forename: Stijn J B
authors.initials: SJ
authors.lastname: van Weyenberg
authors.forename: Nanne K H
authors.initials: NK
authors.lastname: de Boer
mesh_terms: D002760:Cholangiopancreatography, Endoscopic Retrograde; D042883:Choledocholithiasis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D003085:Colic / Q000209:etiology; D003135:Common Bile Duct / Q000473:pathology* / Q000601:surgery; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic; D019160:Endosonography; D005260:Female; D006801:Humans; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000473:pathology* / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D011237:Predictive Value of Tests; D016717:Sphincterotomy, Endoscopic; D016896:Treatment Outcome