A 51-year-old man visited the Sasebo General Hospital because of a niche and a ductal lesion with reflux of barium in the lesser curvature of the gastric body in the upper gastrointestinal series of an annual medical checkup. Endoscopic examination showed an ulcer and a depressed lesion draining yellowish serous liquid in the stomach. Abdominal CT scan and MRCP revealed the ductal structure reached from the lesser curvature of the gastric body to the left lobe of the liver besides the ordinary pancreatobiliary system. ERCP showed normal common bile duct, gall bladder, and right intrahepatic bile duct, while the fistulography using cannula through the gastric depressed lesion revealed an accessory bile duct communicating to the left intrahepatic bile duct. The both biliary systems were completely separated, resulting in the diagnosis of double common bile duct of type IIIa.
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