The dilemma of the duplicated cystic duct: a case report. Issue 6 (19th June 2020)

• Record Type: Journal Article
• Authors: Harding, Tim; Hannan, Enda; Brosnan, Conor; Duggan, William; Ryan, David; Stafford, Anthony; Maguire, Donal
• Is Part Of: Journal of surgical case reports. Volume 2020:Issue 6(2020)
• Publication Date: 2020-06-19
• Subjects: Laparoscopic cholecystectomy -- bile leak -- cystic duct -- cholelithiasis -- gallbladder disease; Surgery -- Periodicals; Surgery -- Case studies -- Periodicals; 617.005
• DOI: 10.1093/jscr/rjaa161
• Languages: English
• ISSNs: 2042-8812

Abstract

Abstract: We present a rare case of a duplicated cystic duct encountered during an elective laparoscopic cholecystectomy in a patient with biliary colic. Prompt recognition of an intraoperative bile leak followed by thorough examination and recognition of the source allowed for timely and appropriate management of the affected patient with a satisfactory post-operative outcome. Our case is unique by the lack of availability of intraoperative cholangiogram at the time of surgery, which posed a significant diagnostic and therapeutic challenge, and by how aberrant anatomy was confirmed intraoperatively by reviewing prior cardiac magnetic resonance imaging. Unremarkable preoperative imaging does not rule out the presence of abnormal anatomy. Early involvement of a specialist hepatobiliary surgeon is essential in an unexplained bile leak, with a low threshold in converting to an open procedure if there is difficulty in clearly deciphering anatomy.