A rare right hepatic duct anatomical variant discovered after laparoscopic bile duct transection

Abstract

Laparoscopic cholecystectomy has been associated with an increased incidence of bile duct injury compared to conventional open cholecystectomy. Injuries are frequently related to surgical inexperience and biliary tract anatomical variations which may be difficult to identify during laparoscopic surgery. A case is reported in which endoscopic retrograde cholangiopancreatography (ERCP) failed to define and resolve a postoperative bile leak that originated from a right anterior hepatic duct. The initial operative report as well as retrograde cholangiograms obtained percutaneously and during restorative surgery localized the site of bile leak to the right anterior hepatic duct which had inserted directly into the gallbladder. Anomalous hepatic ducts require astute surgical intraoperative evaluation to prevent surgical transection, and must be considered if ERCP fails to identify or resolve a continued biliary leak.