Aberrant right hepatic duct presenting as empyema of the gall bladder

Abstract

A 38-year-old male presented with recurrent right hypochondrial pain with history of acute cholecystitis. Ultrasonography of the abdomen showed distended gall bladder with dilated right hepatic duct with intrahepatic biliary dilatation in the right lobe of the liver. Endoscopic retrograde cholangiography showed non-visualization of the right ductal system and gall bladder with extrinsic compression of the common hepatic duct. Contrast-enhanced CT scan revealed a distended gall bladder with isolated dilatation of the intrahepatic biliary dilatation in the right lobe of the liver. Magnetic resonance cholangiography confirmed the same findings. At laparotomy, the right hepatic duct was seen directly inserted into the gall bladder body after a short extrahepatic course. The cystic duct provided the only route for biliary drainage through the gall bladder, but it was blocked. A cholecystectomy with a Roux-en-Y hepaticojejunostomy to the right hepatic duct was carried out. This case presents an extremely rare aberration affecting the extrahepatic biliary tree in which the right hepatic duct was directly inserted into the gall bladder.