Aberrant cholecystohepatic duct

Abstract

A 73-year-old lady presented with colicky central abdominal, anorexia, nausea and rigors. Physical examination revealed that she was afebrile, but had right upper quadrant tenderness, mildly deranged liver function and a white cell count of 25 ¥ 10 9 /L and a C reactive protein of 586 units. Abdominal ultrasound and computerised topography scanning findings were consistent with acute cholecystitis, (a large, thick walled gall bladder with pericholecystic fluid). She was initially treated with intravenous antibiotics and surgery was planned for the following morning.Laparoscopy revealed a gangrenous gall bladder with colon and omentum adherent to it. At laparotomy, an empyema was encountered and retrograde cholecystectomy was performed. An aberrant 4-mm diameter duct was found passing from the lateral aspect of the gall bladder fossa of the liver to the body of the gall bladder. This was divided, cholecystectomy was completed and cholangiography was performed via both the cystic and aberrant ducts (Figs 1,2).The cholangiogram revealed an aberrant duct passing from the cannulation site to join the right posterior segmental duct. As the aberrant duct was not draining a discrete segment of the liver it was able to be ligated. The cystic duct was also ligated. Post-operatively, the patient made an uneventful recovery with no bile leak.

Identification and Management of Bile Leak from Subvescical Bile Duct (“Duct of Luschka”) After Laparoscopic Cholecystectomy. A Systematic Review of Literature.

“…In a study conduct on human fetuses, the incidence of ducts of Luschka was found to be 21.9%. In his recent review, Schnelldorfer 9 establishes a prevalence of SVBD from 4-10% in the general population. However, this data is probably underestimated because of the limited sensitivity of detecting these small ducts.…”