胆嚢肝管の胆嚢摘出術中の術中検出：症例報告

Biliary anatomy is highly variable, and aberrant anatomy increases the risk of bile duct injury during cholecystectomy. Awareness of anatomical variation is essential to prevent avoidable complications. A 37-year-old male with acute gallstone pancreatitis underwent laparoscopic cholecystectomy. Anatomy on intra-operative cholangiography was unclear, prompting conversion to open, where repeat cholangiogram showed the common hepatic duct draining into the gallbladder infundibulum. A subtotal cholecystectomy preserving the infundibulum was performed. The patient developed a bile leak requiring re-look laparotomy and hepaticojejunostomy on post-operative day 5, later revised after anastomotic breakdown. He recovered fully and was well at 1-month follow-up. Cholecystohepatic duct is a rare biliary anomaly that is difficult to detect pre-operatively. Magnetic resonance cholangiopancreatography may help, but is not routine, so a high index of suspicion is crucial. Intra-operative cholangiography and a critical view of safety help to prevent injury. Surgical management depends on anatomy, but generally hepaticojejunostomy is recommended.