Congenital cystohepatic duct found during laparoscopic cholecystectomy

Abstract

This case shows the need for in-depth knowledge also on congenital biliary anomalies that can become subject to iatrogenic damage. The patient is 44-years old with echographically proven cholelithiasis with complaints of intermittent pain in the right upper quadrant. During laparoscopic cholecystectomy, after identification of cystic duct and cystic artery, after their clipping and resection and subsequent mobilization of the gallbladder from the liver parenchyma, a bile duct was opened. Subsequent identification revealed a cystohepatic duct, which is a rare anatomic anomaly. Plastic surgery was performed on the tangential lesion of the right hepatic duct and placement of a transcistic drain, as well as a drain from the right hepatic duct through the Fateri papilla. Postoperative transdrainage cholangiography established the integrity of the bile ducts and the free passage of contrast to the duodenum.

Intraoperative identification of only two structures entering the gallbladder during cholecystectomy—cystic duct and cystic artery—is mandatory.