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Year : 2016  |  Volume : 3  |  Issue : 4  |  Page : 303-304

Double duct sign


1 Department of Gastroenterology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Medicine, Dr. Rajendra Prasad Government Medical College, Kangra, Himachal Pradesh, India
3 Department of Physiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Date of Web Publication14-Sep-2016

Correspondence Address:
Dr. Sujeet Raina
C-15, Type-V Quarters, Dr. Rajendra Prasad Government Medical College Campus, Tanda, Kangra - 176 001, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.190585

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  Abstract 

Double duct sign is an anatomical sign of combined dilatation of common bile duct and pancreatic duct. It is observed on imaging during endoscopic retrograde cholangio-pancreatography, magnetic resonance cholangio-pancreatography, computed tomography and ultrasound. The sign in a jaundiced patient is highly diagnostic of pancreatic carcinoma.

Keywords: Computed tomography, jaundice, pancreas


How to cite this article:
Sharma B, Raina S, Sharma N, Sharma R. Double duct sign. CHRISMED J Health Res 2016;3:303-4

How to cite this URL:
Sharma B, Raina S, Sharma N, Sharma R. Double duct sign. CHRISMED J Health Res [serial online] 2016 [cited 2019 Oct 14];3:303-4. Available from: http://www.cjhr.org/text.asp?2016/3/4/303/190585

A 65-year-old male patient presented with progressive jaundice associated with pruritus of 2 months duration. His liver function tests showed direct bilirubinemia of 35 mg/dl, raised alkaline phosphatase of 1059 U/L, serum aspartate aminotransferase was 68 U/L, and serum alanine aminotransferase was 72 U/L. His ultrasound abdomen revealed dilated common bile duct (CBD) till its lower end with dilated intrahepatic biliary radicles. The computed tomography (CT) scan showed classical double duct sign with a periampullary mass [Figure 1]. Side viewing endoscopy shows localized ulcerated ampulla [Figure 2]. A biopsy from the growth was positive for adenocarcinoma. He underwent an endoscopic retrograde cholangiopancreatography (ERCP) for biliary system drainage. Stent was placed in the CBD to drain biliary system. He underwent pancreaticoduodenectomy (Whipple's) procedure.
Figure 1: Computed tomography performed showing “double duct sign.” A view of the combined dilatation of common bile duct and pancreatic duct

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Figure 2: Side view endoscopy showing ulcerated ampulla

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Freeny et al. coined the term “double duct sign” for the first time in 1976 immediately after the clinical use of ERCP.[1] It is a combined dilatation of CBD and pancreatic duct. This anatomical sign is observed on modalities such as magnetic resonance cholangiopancreatography, CT, ultrasonography in addition to ERCP.[2] The two most common causes of the double-duct sign are carcinoma of the head of pancreas and carcinoma of the ampulla of Vater. Rarely, impacted gall stone in the distal duct, chronic pancreatitis, and ampullary stenosis has been documented as the cause of this sign.[3]

The sign in the presence of jaundice is highly diagnostic of pancreatic carcinoma. In selected patients with an increased likelihood of pancreas cancer, based on the presence of jaundice or observed pancreatic mass on CT-scan, up to 85% of patients did indeed have a pancreas cancer.[4] In patients without jaundice, pancreas cancer was only seen in 6% of patients with a double duct sign.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Freeny PC, Bilbao MK, Katon RM. “Blind” evaluation of endoscopic retrograde cholangiopancreatography (ERCP) in the diagnosis of pancreatic carcinoma: The “double duct” and other signs. Radiology 1976;119:271-4.  Back to cited text no. 1
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2.
Ahualli J. The double duct sign. Radiology 2007;244:314-5.  Back to cited text no. 2
[PUBMED]    
3.
Chandermohan S, Madhusudhanan J, Anbazhagan A, Duraisamy B, Dhalla B, Chandrasekaran S. Common bile duct stone with Mirizzi's Syndrome: Another exception to double duct sign and courvoisier's law? Internet J Surg 2012;28:2.  Back to cited text no. 3
    
4.
Menges M, Lerch MM, Zeitz M. The double duct sign in patients with malignant and benign pancreatic lesions. Gastrointest Endosc 2000;52:74-7.  Back to cited text no. 4
[PUBMED]    
5.
Krishna N, Tummala P, Reddy AV, Mehra M, Agarwal B. Dilation of both pancreatic duct and the common bile duct on computed tomography and magnetic resonance imaging scans in patients with or without obstructive jaundice. Pancreas 2012;41:767-72.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

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