Injury to an accessory bile duct during laparoscopic cholecystectomy

Anatomic variations of the bile duct system are frequent. Accessory cholecystohepatic ducts have been reported, but remain unrecognized in most patients. We present the case of an 53-year-old woman suffering from cholecystolithiasis. Five days after laparoscopic cholecystectomy, symptomatic bile collection in the peritoneal cavity was found. Endoscopic retrograde cholangio-pancreatography (ERCP) with papillotomy showed a bile leak in the gallbladder bed. During relaparoscopy, we were able to identify and to clip an accessory bile duct in the caudal part of the gallbladder bed. Symptomatic injury of an accessory bile duct is a rare complication of laparoscopic cholecystectomy and difficult to prevent. Intraoperatively we recommend the use of operative cholangiography to reveal anatomic variations. Postoperatively the leak can be identified by ERCP, but sphincterotomy should be done simultaneously. If necessary, however, the injury can be repaired by laparoscopic means.