Double cystic duct found by intraoperative cholangiography in laparoscopic cholecystectomy

We report a rare case of double cystic duct in a 74-year-old woman. The patient complained of mild epigastric discomfort, and several stones were discovered by ultrasonography and computed tomography. Any anomalies of the biliary tract were undetectable in the preoperative examinations without direct cholangiography. Laparoscopic cholecystectomy was performed. After clipping the cystic duct close to the gallbladder, as usual, serial intraoperative cholangiography was performed and unexpectedly showed the inflow of contrast medium into the gallbladder via another cystic duct arising from the right hepatic duct, thus revealing one gallbladder and two cystic ducts, one of which joined the common hepatic duct and the other the right hepatic duct. There was only one cystic artery that arose from the right hepatic artery and accompanied the primary cystic duct to be distributed to the gallbladder. The existence of contrast medium in the resected specimen was confirmed by radiography. No complications occurred during or after laparoscopic cholecystectomy. This is the first report of double cystic duct found in laparoscopic cholecystectomy. We recommend routine preoperative or intraoperative cholangiography.