ABSTRACT
Ectopic opening of the common bile duct (CBD) in the duodenal bulb is not an incidental finding, but a pathologic condition that can be associated with clinical entities, such as recurrent duodenal ulcer, choledocholithiasis. or cholangitis. We report a case of ectopic CBD with hematemesis in a 61 year-old male patient. Esophagogastroduodenoscopy showed several active ulcers with a fresh blood clot at the duodenal bulb, which had a mucosal deformity and a small opening with suspicious drainage of bile, and the second part of the duodenum had no papilla-like structure. MRCP showed a trident-like pancreatobiliary tree. The biliary tree was visualized via a suspicious ectopic opening of the bile duct at the duodenal bulb. The distal CBD looked hook-shaped and had no filling defect. We report a unique case of ectopic opening of the CBD in the duodenal bulb, which presented as hematemesis.