Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2022 Apr 4;17(6):1843-1847.
doi: 10.1016/j.radcr.2022.03.031. eCollection 2022 Jun.

Modified and dynamic intraoperativecholangiography during laparoscopic cholecystectomy in two patients with aberrant right posterior hepatic duct

Fumio Chikamori  1 , Koji Ueta  1 , Jun Iwabu  1 , Niranjan Sharma  2
Affiliations
Case Reports

Modified and dynamic intraoperativecholangiography during laparoscopic cholecystectomy in two patients with aberrant right posterior hepatic duct

Fumio Chikamori et al. Radiol Case Rep. .

Abstract

Aberrant right posterior hepatic duct (ARPHD) is one of the anatomical anomalies of the bile duct. It is a risk factor for bile duct injury during laparoscopic cholecystectomy (LC). ARPHD can be diagnosed before surgery by magnetic resonance cholangiopancreatography or drip infusion cholangiographic-computed tomography. However, it is not easy to identify ARPHD during LC. Classic intraoperative cholangiography (IOC) procedure that does not lead to bile duct injury avoidance needs to be modified. In modified IOC, cannulation is performed from the infundibulum or neck of the gallbladder. We reported a modified and dynamic IOC procedure that can identify ARPHD safely and precisely during LC. The modified IOC provided direct evidence of no injury to ARPHD in 2 cases.

Keywords: Aberrant right posterior hepatic duct; Bile duct injury; DIC-CT; Intraoperative cholangiography; Laparoscopic cholecystectomy; MRCP.

PubMed Disclaimer

Figures

Fig 1 –
Fig. 1
Anteroposterior view (A) and caudal view (B) of MRCP in case 1 show ARPHD draining into the extrahepatic bile duct (arrow). ARPHD, aberrant right posterior hepatic duct; MRCP, magnetic resonance cholangiopancreatography.
Fig 2 –
Fig. 2
Laparoscopic view in case 1 shows the infundibulum of the gallbladder (A) that is ligated and pulled up (B). The laparoscopic view shows a small incision made at the infundibulum (C, D) and an inserted cannula for cholangiography (E, F).
Fig 3 –
Fig. 3
Modified IOC in case 1 shows no injury to ARPHD and no bile duct stone. ARPHD, aberrant right posterior hepatic duct; IOC, intraoperative cholangiography.
Fig 4 –
Fig. 4
Anteroposterior view (A) and caudal view (B) of MRCP in case 2 show ARPHD draining into the extrahepatic bile duct (arrow). ARPHD, aberrant right posterior hepatic duct; MRCP, magnetic resonance cholangiopancreatography.
Fig 5 –
Fig. 5
Endoscopic retrograde cholangiography 1 year ago in case 2 shows no ARPHD. ARPHD, aberrant right posterior hepatic duct.
Fig 6 –
Fig. 6
Dynamic IOC in case 2: Laparoscopic view (A) and anteroposterior view of cholangiogram (A’) show that the ARPHD overlaps with the cystic duct and is unclear. After pulling the cholangiograsper (black arrow) to the caudal side (B), the left anterior oblique view of cholangiogram (B’) shows the presence of ARPHD in addition to the cystic duct, but the peripheral bile ducts overlap with grasping forceps and are not clear. After pulling the grasping forceps (white arrow) to the outside (C), the left anterior oblique view of cholangiogram (C’) shows that the ARPHD (black arrow) is visualized throughout the peripheral bile ducts. There is no injury to ARPHD and no residual stone. ARPHD, aberrant right posterior hepatic duct; IOC, intraoperative cholangiography.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Uchiyama K, Tani M, Kawai M, Ueno M, Hama T, Yamaue H. Preoperative evaluation of the extrahepatic bile duct structure for laparoscopic cholecystectomy. Surg Endosc. 2006;20(7):1119–1123. doi: 10.1007/s00464-005-0689-1. - DOI - PubMed
    1. Ohkubo M, Nagino M, Kamiya J, Yuasa N, Oda K, Arai T, et al. Surgical anatomy of the bile ducts at the hepatic hilum as applied to living donor liver transplantation. Ann Surg. 2004;239(1):82–86. doi: 10.1097/01.sla.0000102934.93029.89. - DOI - PMC - PubMed
    1. Kitami M, Takase K, Murakami G, Ko S, Tsuboi M, Saito H, et al. Types and frequencies of biliary tract variations associated with a major portal venous anomaly: analysis with multi-detector row CT cholangiography. Radiology. 2006;238(1):156–166. doi: 10.1148/radiol.2381041783. - DOI - PubMed
    1. Noji T, Nakamura F, Nakamura T, Kato K, Suzuki O, Ambo Y, et al. ENBD tube placement prior to laparoscopic cholecystectomy may reduce the rate of complications in cases with predictably complicating biliary anomalies. J Gastroenterol. 2011;46(1):73–77. doi: 10.1007/s00535-010-0281-x. - DOI - PubMed
    1. Kurata M, Honda G, Okuda Y, Kobayashi S, Sakamoto K, Iwasaki S, et al. Preoperative detection and handling of aberrant right posterior sectoral hepatic duct during laparoscopic cholecystectomy. J Hepatobiliary Pancreat Sci. 2015;22(7):558–562. doi: 10.1002/jhbp.252. - DOI - PubMed

Publication types

LinkOut - more resources