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Dextrocholedocholithiasis: calculous obstruction complicating double ductus choledochus in an adult
R W Thompson1, D G Clair, T J Eberlein
1Cushing Surgical Service, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
Insights
Double ductus choledochus, a rare biliary anomaly, involves two common bile ducts. This case highlights potential surgical injury risks and management strategies for this congenital condition.
Area of Science:
- Gastroenterology and Hepatobiliary Surgery
- Embryology and Congenital Anomalies
Background:
- Double ductus choledochus is a rare congenital anomaly of the extrahepatic biliary tree.
- This condition involves the common bile duct being duplicated, presenting as two independent hepatic ducts.
Observation:
- Patients with double ductus choledochus may exhibit asymptomatic biliary drainage.
- The anomaly is occasionally discovered during surgery for symptomatic cholelithiasis (gallstones).
- A specific case involved doubled biliary ducts identified during cholecystectomy, with calculous obstruction in the right duct (ductus choledochus dextri).
Findings:
- The presence of double ductus choledochus can lead to significant injury to the biliary tree if not recognized.
- Calculous obstruction within one of the duplicated ducts poses a specific surgical challenge.
Implications:
- Accurate identification and careful surgical management are crucial when double ductus choledochus is encountered.
- Understanding this embryologic anomaly is vital for preventing iatrogenic injury during biliary surgery.
- This case underscores the importance of intraoperative awareness for rare biliary duct variations.
Abstract:
Double ductus choledochus is a rare anomaly of the extrahepatic biliary tree in which the common bile duct is represented by two independent hepatic ducts. Patients with this abnormality may have unimpeded biliary drainage and remain symptom free, yet various forms of double ductus choledochus are occasionally encountered in patients undergoing operation for symptomatic cholelithiasis. We describe a patient in whom doubled biliary ducts were identified on exploration for cholecystectomy along with calculous obstruction of the right-sided duct (ductus choledochus dextri). This case illustrates the potential for significant injury to the biliary tree when double ductus choledochus is present. In addition to a means by which to manage this problem at the time of operation, a review of the literature, as well as a description of this rare embryologic abnormality, is presented.