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Hepatic duct transection during laparoscopic cholecystectomy
S A Battaglia1, W F Pizzi, S C Khaneja
1Dept. of Surgery, Catholic Medical Center of Brooklyn and Queens, Jamaica, NY 11432.
Insights
A rare anatomical variation in bile duct anatomy can complicate laparoscopic cholecystectomy. The right hepatic duct drained into the gallbladder, requiring surgical correction via laparotomy.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Surgical Anatomy
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstones.
- Variations in biliary anatomy can pose challenges during this procedure.
- Accurate identification of biliary structures is crucial for surgical safety.
Observation:
- A rare case of right hepatic duct draining into the gallbladder infundibulum was observed during laparoscopic cholecystectomy.
- This anomalous duct formed a confluence with the left hepatic duct, creating the common bile duct.
- The anomaly was identified after initial gallbladder mobilization.
Findings:
- The anomalous right hepatic duct was inadvertently transected during the laparoscopic procedure.
- Subsequent laparotomy was necessary to manage the iatrogenic injury.
- A right hepatic duct enteric anastomosis was successfully created.
Implications:
- This case highlights a potential pitfall in laparoscopic cholecystectomy due to biliary anatomical variations.
- Awareness of such anomalies is critical for surgeons to prevent intraoperative complications.
- Preoperative imaging may aid in identifying rare biliary ductal variations to improve surgical outcomes.
Abstract:
A rare anatomical variation was encountered during a laparoscopic cholecystectomy. The right hepatic duct emptied into the infundibulum of the gallbladder. This confluence then joined the left hepatic duct to form the common bile duct. The right hepatic duct was transected between the gallbladder and the common bile duct as a normal cystic duct would have been isolated and divided laparoscopicaly. This anatomic variant was recognized after further mobilization of the gallbladder from the liver bed. A laparotomy was performed to create a right hepatic duct enteric anastomosis. The case illustrates one possible pitfall that may be encountered during laparoscopic cholecystectomy.