A 64-year-old man visited Shiga University of Medical Science Hospital with complaints of tenderness from the right hypochondrium to the epigastrium. Computed tomography with drip infusion cholangiography (DIC-CT) showed aberrant right posterior hepatic duct (ARPHD) draining into the extrahepatic bile duct (Picture 1, 2). We diagnosed him with cholecystitis complicated with a biliary anomaly, wherein the rear section branch merged into the common bile duct on the duodenum side from the confluence part of the cystic duct. This type of anatomical abnormality is very rare (frequency: 0.19%) (1). Laparoscopic cholecystectomy was performed, and no postoperative complications were observed.
Picture 1.
Picture 2.
Anatomical abnormalities in the biliary tract cause biliary tract injury during cholecystectomy. In our case, preoperative diagnostic imaging by DIC-CT was useful for preventing biliary tract injury due to the misidentification of an ARPHD as a cystic duct (1,2).
The authors state that they have no Conflict of Interest (COI).
References
- 1.Uchiyama K, Tani M, Kawai M, et al. Preoperative evaluation of the extrahepatic bile duct structure for laparoscopic cholecystectomy. Surg Endosc 20: 1119-1123, 2006. [DOI] [PubMed] [Google Scholar]
- 2.Moossa AR, Easter DW, Snnenberg EV, et al. Laparoscopic injuries to the bile duct. Ann Surg 215: 203-208, 1992. [DOI] [PMC free article] [PubMed] [Google Scholar]