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Laparoscopic Common Bile Duct Exploration Followed by Primary Suture Using a Modified Bile Duct Incision
Published on: May 2, 2025
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Accessory bile duct: a rare but important anatomical variant
Anthony S Casabianca1, Mihir M Shah2, Darren Carpizo2
1Department of General Surgery, Rutgers Robert Wood Johnson Medical School New Brunswick, New Brunswick, New Jersey, USA.
BMJ Case Reports
|June 20, 2018
Summary
A rare accessory bile duct complicated pancreatic surgery, leading to bile leak and sepsis in an elderly patient. This case highlights the importance of intraoperative imaging for identifying biliary anomalies during pancreaticoduodenectomy.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Surgical Anatomy
- Oncology
Background:
- Pancreatic adenocarcinoma treatment often involves neoadjuvant therapy followed by surgical resection.
- Pancreaticoduodenectomy (Whipple procedure) is a complex surgery with potential complications.
- Bile leaks are a known complication following pancreaticoduodenectomy.
Observation:
- An 84-year-old male with pancreatic adenocarcinoma developed an early bile leak post-pancreaticoduodenectomy.
- Intraoperative cholangiogram revealed an accessory common bile duct to segment 5 of the right hepatic lobe.
- This anomalous duct was ligated during re-exploration.
Findings:
- The patient experienced a complicated postoperative course.
- Biliary stasis developed secondary to the ligation of the accessory duct.
- Sepsis ensued as a complication of biliary stasis.
Implications:
- This case underscores the critical role of intraoperative cholangiography in identifying aberrant biliary anatomy.
- Recognition and management of accessory bile ducts are crucial to prevent postoperative complications like biliary stasis and sepsis.
- Anatomical variations in the biliary system can significantly impact surgical outcomes in pancreatic surgery.
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