Recognition and Surgical Management of Aberrant Right Hepatic Duct Originating From the Cystic Duct

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Anatomy
• Congenital Anomalies

Background:

• Aberrant right hepatic ducts are rare congenital biliary system anomalies.
• Failure to identify these anomalies can lead to severe post-operative complications.
• Laparoscopic cholecystectomy is a common procedure, but anatomical variations pose surgical challenges.

Observation:

• A patient developed a bile leak post-laparoscopic cholecystectomy for chronic cholecystitis.
• Re-exploration revealed a cystic stump leak and a Hisatsugu type V aberrant right hepatic duct.
• The anomaly originated from the cystic duct, a highly unusual anatomical variation.

Findings:

• The aberrant duct was successfully identified during re-exploration.
• Management involved oversewing the cystic duct stump and surgical drainage.
• The patient's bile leak was resolved following the intervention.

Implications:

• Highlights the critical importance of pre-operative recognition of biliary anomalies.
• Underscores the potential for serious complications when aberrant ducts are missed.
• Demonstrates management strategies for rare hepatic duct anomalies in resource-limited settings.
• Emphasizes the need for meticulous surgical technique in cholecystectomy.
• Provides a valuable case study for surgical training and awareness.