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. 2019:56:78-81.
doi: 10.1016/j.ijscr.2019.02.030. Epub 2019 Feb 28.

Case report of a duplicated cystic duct: A unique challenge for the laparoscopic surgeon

Semeret Munie  1 , Hassan Nasser  2 , Pauline H Go  3 , Kelly Rosso  4 , Ann Woodward  1
Affiliations

Case report of a duplicated cystic duct: A unique challenge for the laparoscopic surgeon

Semeret Munie et al. Int J Surg Case Rep. 2019.

Abstract

Introduction: Anatomical variants of the extrahepatic biliary tree are numerous, adding significantly to the risk of bile duct injury during cholecystectomy, especially when laparoscopic approach is employed. Duplicated cystic ducts draining a single gallbladder are extremely rare.

Presentation of case: A 34-year-old female presented with signs and symptoms of acute cholecystitis which was confirmed on imaging. She was found to have an accessory cystic duct on laparoscopic cholecystectomy requiring conversion to open laparotomy with intraoperative cholangiogram to delineate the anatomy.

Discussion: In the English literature, there has been 20 reported cases of double cystic duct with a single gallbladder. Most of these cases were diagnosed intraoperatively despite the completion of a preoperative endoscopic retrograde cholangiopancreatography in a few of these patients.

Conclusion: The limited success of preoperative biliary tract imaging in demonstrating anatomic aberrancies prior to cholecystectomy clearly highlights the importance of maintaining constant vigilance for even the slightest anatomic abnormality at operation. Any uncertainty or concern for ductal injury mandates immediate operative cholangiogram with cannulation of all structures in question.

Keywords: Bile duct variation; Double cystic duct; Duplicated cystic duct; Laparoscopic cholecystectomy.

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Figures

Fig. 1
Fig. 1
Schematic demonstration of the visualized anatomy intraoperatively.
Fig. 2
Fig. 2
Intraoperative cholangiogram through main cystic duct showing correct ductal anatomy with intact common bile, common hepatic, as well as right and left hepatic ducts.
Fig. 3
Fig. 3
Cholangiogram through accessory duct failing to fill bile duct due to blocked proximal aspect of lumen.
See this image and copyright information in PMC

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