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Cholecystohepatic duct detected during laparoscopic cholecystectomy: a case report
Koki Maeda1, Masami Tabata2, Tatsuya Sakamoto2
1Department of Hepatobiliary-Pancreatic and Transplant Surgery, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-0001, Japan. kokimaeda@clin.medic.mie-u.ac.jp.
Insights
Injury to the rare cholecystohepatic duct during laparoscopic cholecystectomy can cause complications. Surgeons must be aware of this aberrant bile duct anomaly and manage it appropriately, even if detected intraoperatively.
Area of Science:
- Gastroenterology
- Surgical Anatomy
- Hepatobiliary Surgery
Background:
- The cholecystohepatic duct is a rare aberrant hepatic duct connecting to the gallbladder.
- Injury during cholecystectomy can lead to severe complications.
Purpose of the Study:
- To present a case of cholecystohepatic duct identified during laparoscopic cholecystectomy.
- To highlight the importance of recognizing and managing this anomaly.
Main Methods:
- A 77-year-old woman underwent laparoscopic cholecystectomy for cholecystolithiasis.
- A cholecystohepatic duct was identified and managed intraoperatively.
- Postoperative follow-up included imaging and liver function tests.
Main Results:
- The cholecystohepatic duct was injured during gallbladder dissection.
- Biliary reconstruction was not required due to the small drainage area.
- Postoperative course was uneventful with normal liver function and no cholangitis symptoms at 42 months.
Conclusions:
- Awareness of the rare cholecystohepatic duct is crucial for surgeons performing cholecystectomy.
- Preoperative detection is ideal, but intraoperative identification requires appropriate management based on drainage area.
- Minimizing injury to aberrant ducts prevents serious postoperative complications.
Background:
The cholecystohepatic duct is a rare form of an aberrant hepatic duct that connects to the gallbladder. Although cholecystohepatic duct is reported to be a very rare anomaly, injury of cholecystohepatic duct during cholecystectomy may result in serious complications. Herein, we present a case of cholecystohepatic duct in the ventral branch of the right posterior inferior segmental bile duct detected during laparoscopic cholecystectomy.
Case Presentation:
A 77-year-old woman with cholecystolithiasis had been referred to our hospital for surgery. Drip infusion cholecystocholangiography-computed tomography revealed a bile duct branch without communication between the intra- and extrabiliary systems, although the existence of this aberrant hepatic duct was not suspected preoperatively. A 4-port laparoscopic cholecystectomy was performed. After critical view of safety was confirmed, the cystic artery and duct were divided after double clipping. During antegrade mobilization of the gallbladder from the gallbladder bed, a thin, white cord-like material connecting the gallbladder neck and bed was detected. After clipping and dividing it, a cholecystohepatic duct injury was recognized through rechecking the results of the preoperative examinations. Biliary reconstruction was considered unnecessary because of the lesion's small drainage area. The postoperative course was uneventful, and an enhanced computed tomography performed 6 months after the surgery revealed a dilation in the ventral branch of the right posterior inferior segmental bile duct. The patient's liver function remained normal, and she had no symptoms of cholangitis 42 months after the surgery.
Conclusions:
Although cholecystohepatic duct is a rare anomaly compared to other aberrant hepatic ducts, surgeons performing cholecystectomy should always keep its existence in mind to avoid serious postoperative complications. Ideally, preoperative detection of cholecystohepatic duct is preferable, but even if it is detected during surgery, the appropriate management according to the drainage area is also important.
